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Du-Moxibustion in a Mouse Model of Ankylosing Spondylitis
Published on: October 27, 2023
Plasma homocysteine status in patients with ankylosing spondylitis
James Cheng-Chung Wei1, Ming-Shiou Jan, Chen-Tung Yu
1Division of Allergy, Immunology and Rheumatology, Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
Insights
Ankylosing spondylitis patients treated with sulfasalazine or methotrexate showed increased homocysteine levels. Supplementing with B vitamins (B-12, B-6, folic acid) effectively lowered homocysteine in these patients.
Area of Science:
- Rheumatology
- Clinical Biochemistry
Background:
- Hyperhomocysteinemia is linked to vascular diseases and autoimmune conditions like psoriasis, lupus, and rheumatoid arthritis.
- Elevated homocysteine (Hcy) levels may be a concern in patients with inflammatory conditions.
Purpose of the Study:
- To investigate changes in plasma Hcy levels in ankylosing spondylitis (AS) patients before and after treatment with sulfasalazine and methotrexate (MTX).
- To assess the efficacy of B-vitamin supplementation in reducing elevated Hcy levels in AS patients.
Main Methods:
- A cross-sectional case-control study involving 102 AS patients and 10 healthy controls.
- Plasma Hcy levels were measured using ELISA kits.
- Correlation analysis was performed between Hcy levels, disease activity (BASDAI), and DMARD usage. A prospective trial supplemented B vitamins for patients with Hcy >or=15 micromol/l.
Main Results:
- AS patients on sulfasalazine, MTX, or combination therapy exhibited significantly higher plasma Hcy levels compared to controls and AS patients without DMARDs.
- No significant correlation was found between disease activity (BASDAI) and plasma Hcy levels.
- A 2-week daily supplement of vitamin B-12, B-6, and folic acid significantly reduced Hcy levels in patients with elevated Hcy.
Conclusions:
- Sulfasalazine and MTX treatments significantly increase plasma Hcy levels in AS patients.
- B-vitamin supplementation (B-12, B-6, folic acid) is effective in lowering elevated Hcy levels in AS patients undergoing these treatments.
- Routine B-vitamin supplementation should be considered for AS patients treated with sulfasalazine and/or MTX.
Abstract:
Homocysteine (Hcy), a sulfur-containing amino acid, is eliminated through B vitamins-dependent pathways. Hyperhomocysteinemia has been found to be an independent risk factor for atherosclerotic cardiovascular, cerebrovascular, and peripheral vascular diseases. Recently, psoriasis, lupus, and rheumatoid arthritis were reported to be associated with hyperhomocysteinemia. This study was aimed to evaluate the changes of plasma Hcy level before and after sulfasalazine and MTX therapy in patients with ankylosing spondylitis (AS). One hundred and two patients with AS and ten normal controls were enrolled in the cross-sectional case-control study. Fasting plasma Hcy levels were determined by ELISA kits (IMX, Abbott). Hcy levels were compared to their Bath AS disease activity index (BASDAI) and the usage of sulfasalazine and/or MTX. Active disease was defined by BASDAI as more than 3 in a 10-cm scale with ESR >20 mm/h. For those patients with plasma Hcy >or=15 micromol/l, a perspective trial of daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg for 2 weeks were also tested for the efficacy. Plasma Hcy level increased significantly in AS patients under sulfasalazine (10.4+/-3.8 micromol/l, p<0.05), MTX (11.9+/-4.7, p<0.05) and sulfasalazine/MTX combination treatment (11.2+/-2.6, p<0.05) compared with normal controls (8.6+/-1.2 micromol/l) and AS patients without DMARD(9.4+/- 2.6 micromol/l). No correlation between disease activity and plasma Hcy level was found. Daily supplement of vitamin B-12 0.5 mg, B-6 50 mg, and folic acid 5 mg can lower Hcy level in 2 weeks (32.3+/-24.0 vs 15.6+/-11.1 micromol/l, p=0.007). Plasma homocysteine level did significantly increase in AS patients under sulfasalazine or MTX treatment. B-vitamins should be considered as a routine supplementation for patients who underwent sulfasalazine and/or MTX treatment. Further longitudinal studies are required to confirm the conclusions.
