[Hyperhomocysteinemia in children and adolescents with systemic lupus erythematosus: evolutive evaluation]

One of the mechanisms implicated in the pathogenesis of coronary heart disease in patients with juvenile systemic lupus erythematosus (SLE) is the hyperhomocysteinemia. Our aim was to follow patients with juvenile SLE and to identify the presence and the persistence of hyperhomocysteinemia.

We studied 18 patients with juvenile SLE (median age 13.5 y). A survey of demographic and clinic data was performed based on patients records. The plasma homocysteine concentration was performed twice with a median interval of 1.5 years (1.3-2.5) and association with nutritional status, disease activity, renal involvement and use of methotrexate was sought. The plasma homocysteine concentration was also evaluated in 59 healthy controls, sex and age-matched to the patients.

Of the 18 patients with juvenile SLE, 16 (88.9%) were female and 13 (72.2%) had renal involvement. Five out of 18 patients (27.8%) persisted with increased concentration of plasma homocysteine (above the 90th percentile of the healthy group). The elevated concentration of homocysteine did not show statistically significant association neither with renal involvement (in the first dosage, p=0.676 and in the second, p=0.500), disease activity (in the first dosage, p=0.630 and in the second, p=0.182), overweight/obesity (in the first dosage, p=0.485 and in the second, p=0.288) nor with short stature (in the first dosage, p=0.202 and in the second, p=0.500).

This study emphasizes the persistence of elevated concentration of homocysteine in some patients with juvenile SLE and the need for evaluations of therapeutic strategies and nutritional education aiming to reduce risk factors of cardiovascular disease.