Skip Navigation



Rheumatology Advance Access published online on April 16, 2003
Rheumatology, doi:10.1093/rheumatology/keg293
Rheumatology © British Society for Rheumatology 2003; all rights reserved
This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
42/9/1055    most recent
keg293v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Martinez-Taboada, V. M.
Right arrow Articles by Lopez-Hoyos, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Martinez-Taboada, V. M.
Right arrow Articles by Lopez-Hoyos, M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© 2003 British Society for Rheumatology 2003; all rights reserved

Original Papers

Homocysteine levels in polymyalgia rheumatica and giant cell arteritis: influence of corticosteroid therapy

V. M. Martinez-Taboada 1*, M. J. Bartolome 2, M. D. Fernandez-Gonzalez 3, R. Blanco 1, V. Rodriguez-Valverde 1, M. Lopez-Hoyos 4

1 Division of Rheumatology, Hospital Universitario ‘Marqués de Valdecilla', Facultad de Medicina, Universidad de Cantabria, Santander, Spain
2 Division of Immunology, Hospital Universitario ‘Marqués de Valdecilla', Facultad de Medicina, Universidad de Cantabria, Santander, Spain
3 Division of Biochemistry, Hospital Universitario ‘Marqués de Valdecilla', Facultad de Medicina, Universidad de Cantabria, Santander, Spain
4 Division of Immunology, Hospital Universitario ‘Marqués de Valdecilla', Facultad de Medicina, Universidad de Cantabria, Santander, Spain

* Corresponding author. E-mail: vmartinezt{at}medynet.com.

Received 20 September 2002 ; accepted 27 January 2003

Abstract

Objectives. It has been suggested that patients with giant cell arteritis (GCA) may share a common pathway with atherosclerosis. Furthermore, patients with GCA and polymyalgia rheumatica (PMR), in addition to advanced age, are treated for prolonged periods of time with corticosteroids, a factor that can also accelerate atherosclerosis. Hyperhomocysteinaemia is considered an independent risk factor for atherosclerosis, and might play a role in ischaemic manifestations that occur with a variable frequency during the course of GCA. The purposes of the present study were: (i) to analyse the plasma levels of homocysteine in patients with GCA and PMR, (ii) to determine the influence of corticosteroid therapy on the homocysteine levels and (iii) to analyse if the levels of homocysteine may predict the development of ischaemic complications in patients with GCA.

Methods. Plasma homocysteine concentration was measured in 56 patients with active PMR/GCA (17 GCA and 39 isolated PMR) before steroid treatment and 23 healthy age-matched volunteers were used as controls. The total plasma homocysteine level was quantified using a fluorescent polarization immunoassay.

Results. Homocysteine concentrations were higher in PMR and GCA patients than age-matched controls (P < 0.05). Patients with GCA had slightly higher levels of plasma homocysteine than those with isolated PMR (13.6±4.3 vs 12.7±3.1 µmol/l, P=0.6). In 30 of these patients (12 GCA and 18 PMR) a second measurement of homocysteine concentration was done when they were in clinical remission with steroid treatment. The post-treatment levels of homocysteine were significantly increased in GCA rather than in PMR patients. In 13 patients with homocysteine levels above the normal upper limit of our laboratory, therapy with folic acid and/or vitamin B12 was started. After 3 months of vitamin supplements, the homocysteine concentration significantly decreased from 19.2±3.1 to 13.6±3.2 µmol/l (P=0.001). Such decrease was less marked in the PMR than in GCA patients. Ten out of the 17 patients with GCA had ischaemic manifestations of the disease. The levels of homocysteine were slightly higher in GCA patients with ischaemia than in those without ischaemic manifestations, although the difference did not reach statistical significance (15±4.9 vs 11.6±1.9 µmol/l, P=0.46).

Conclusions. Patients with active PMR and GCA had elevated plasma concentrations of homocysteine. Corticosteroid therapy significantly increased such levels, especially in GCA patients. Treatment with supplements of folic acid and/or vitamin B12 reduced the homocysteine concentrations. These data support the hypothesis that patients with GCA (and to a lesser extend PMR patients) may share a common pathway with atherosclerosis and suggest a new atherogenic mechanism of corticosteroids.

Key words: Polymyalgia rheumatica, Giant cell arteritis, Homocysteine, Corticosteroids, Folic acid, Vitamin B12.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 J. Clin. Endocrinol. Metab.Home page
A. Faggiano, D. Melis, R. Alfieri, M. De Martino, M. Filippella, F. Milone, G. Lombardi, A. Colao, and R. Pivonello
Sulfur Amino Acids in Cushing's Disease: Insight in Homocysteine and Taurine Levels in Patients with Active and Cured Disease
J. Clin. Endocrinol. Metab., December 1, 2005; 90(12): 6616 - 6622.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.