Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Clinical Immunology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Mod Rheumatol. 2023 Aug 25;33(5):911-917. doi: 10.1093/mr/roac106.
We aimed to determine the clinical impact of plasma homocysteine levels on disease activity and clinical remission in patients with rheumatoid arthritis (RA).
A cross-sectional study was conducted using KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) database. We enrolled 291 female patients, who were treated in a treat-to-target manner. We measured plasma total homocysteine using a liquid chromatography-tandem mass spectrometry system and collected clinical data including a 28-joint RA disease activity score-erythrocyte sedimentation rate (DAS28-ESR). Clinical remission of disease activity was defined as a DAS28-ESR < 2.6.
In a univariable analysis, the plasma homocysteine concentration was significantly and positively associated with DAS-28-ESR and was higher in the non-remission group than in the remission group. The cutoff value of the plasma homocysteine level was calculated to be 7.9 nmol/mL by the test of the receiver operating characteristic curve analysis. In a multivariable analysis, after adjusting for clinically relevant variables, the high homocysteine level remained a significant positive association for DAS28-ESR (estimate 0.27, P = .0019) and a positive factor for the presence of RA non-remission (odds ratio 2.39, P = .0071).
Increased plasma homocysteine levels showed a significant positive association with current disease activity and the non-remission state in female patients with RA under treat-to-target treatment. The findings suggest the potential utility of plasma homocysteine as a disease state marker reflecting conditions that are treatment failure and difficult to remission and may provide clinical evidence on the interplay between homocysteine and inflammatory activation in RA.
我们旨在确定血浆同型半胱氨酸水平对类风湿关节炎（RA）患者疾病活动度和临床缓解的临床影响。
采用京都大学类风湿关节炎管理联盟（KURAMA）数据库进行横断面研究。我们纳入了 291 名接受靶向治疗的女性患者。我们使用液相色谱-串联质谱系统测量血浆总同型半胱氨酸，并收集了包括 28 个关节 RA 疾病活动评分-红细胞沉降率（DAS28-ESR）在内的临床数据。疾病活动的临床缓解定义为 DAS28-ESR<2.6。
在单变量分析中，血浆同型半胱氨酸浓度与 DAS28-ESR 呈显著正相关，且在未缓解组中高于缓解组。通过接受者操作特征曲线分析的检验，计算出血浆同型半胱氨酸水平的截断值为 7.9 nmol/mL。在多变量分析中，在校正了临床相关变量后，高同型半胱氨酸水平仍然与 DAS28-ESR 呈显著正相关（估计值 0.27，P=0.0019），并且是 RA 未缓解的阳性因素（比值比 2.39，P=0.0071）。
在接受靶向治疗的女性 RA 患者中，升高的血浆同型半胱氨酸水平与当前疾病活动度和未缓解状态呈显著正相关。这些发现表明，血浆同型半胱氨酸作为反映治疗失败和难以缓解的疾病状态标志物具有潜在的应用价值，并且可能为同型半胱氨酸与 RA 中炎症激活之间的相互作用提供临床证据。
