Expression Of Homocysteine And Adiponectin In Rheumatoid Arthritis

Objective: Rheumatoid arthritis is a common systemic disease thatmanifests as symmetric polyarthritis. Recently, many researchers haveobserved that cardiovascular disease (CVD) was the capital death cause of RA.Recent studies showed that homocysteine (HCY) and adiponectin (ADP), theindependent risk factors in coronary arteriosclerotic heart disease, wereassociated with the pathogenesis of RA. The aim of this study was toinvestigate the risk of CVD with RA through detecting the serum levels ofHCY and ADP in parients with rheumatoid arthritis.Methods:30RA patients were studied, all of whom corresponded withAmerican Rheumatism Institute and European congress prevention federationrheumatoid arthritis diagnostic criteria of2009. All patients were excludedcardiovascular disease, diabetes mellitus, management with glucocorticoid(GC), disease modifying antirheumatic drug (methotrexate, leflunomide) orbiological agents (etanercept, infliximab) in six months. Serum levels of HCYand ADP were measured by avidin biotin peroxidase complex enzyme-linkedimmunosorbent assay (ABC-ELISA) in cases of RA pre and post-treatmentwith disease modifying antirheumatic drug, and compared with normalcontrols and diabetes mellitus (DM) controls. The laboratory parameters ofRA patients were recorded such as ESR, CRP, RF, PLT and HDL-C. Thecorrelations were analyzed between HCY, ADP and clinical parameters.According to the different of disease modifying antirheumatic drug, the RAgroup were divided into two subgroups MTX treatment group and LEFtreatment group, and statistical analysis was performed.All the data were analyzed by SPSS17.0for Windows statistical software.The mean number±standard deviation (x±s) was used to express themeasurement data. The t or t’ test was used for the comparison of two samples and Chi-square test was used for the comparison of the enumeration data, andthe paired-samples t test was used for the comparison of pre andpost-treatment’s data. Linear correlation analysis was performed forcorrelation analysis. P value less than0.05was considered statisticallysignificant.Results:1General data description of RA group and control groups: The study groupcomprised30RA patients (20women and10men). The mean age was50.43±12.66years (range22to71years). The mean medain duration was3years (range2months to26years). The mean body mass index (BMI) was(23.80±3.29) kg/m~2. The normal control comprised20subjects (12womenand8men). The mean age was44.25±6.92years (range34to57years). Themean BMI was (22.62±2.00) kg/m~2. The diabetes mellitus (DM) controlgroup comprised20DM patients (12women and8men). The mean age was51.30±14.07years (range18to86years). The mean BMI was (25.84±2.83)kg/m~2. There were no differences between the RA group and control group inage and gender (P>0.05).2Serum levels of indexes2.1Serum levels of HCY2.1.1The serum levels of HCY in RA group were (6.63±2.75) μmol/L, whichwere significantly higher than normal controls (4.30±2.12) μmol/L (P=0.003).The serum levels of HCY in DM group were (6.69±2.97) μmol/L. And therewas no statistical difference between RA group and DM controls (P>0.05).2.1.2After6months of treatment, the serum levels of HCY in RA group were(7.05±2.72) μmol/L, which were significantly higher than prior treatment(P=0.029). The laboratory parameters of RA group, such as DAS28, ESR,CRP, PLT and RF were significantly decreased than prior treatment (P<0.05).After6months of treatment, the changes of levels of HCY were significantdifferent between methotrexate group and leflunomide group. The levels ofHCY in methotrexate group significantly increased (6.84±3.15μmol/L vs7.74±3.07μmol/L)(P=0.007), while there was no significant change in leflunomide group (6.43±2.38μmol/L vs3.37±2.22μmol/L)(P=0.739).2.2Serum levels of ADP2.2.1The serum levels of ADP in RA group were (208.12±74.06) μg/L, whichwere lower than normal controls (241.73±82.05) μg/L and higher than DMcontrols (195.95±62.03) μg/L, while there was no statistical difference in thethree groups (P>0.05).2.2.2After6months of treatment, the serum levels of ADP in RA group were(208.15±75.17)μg/L, which were higher than prior treatment, but no statisticaldifference (P=0.989). The levels of ADP were no significant change either inmethotrexate group (183.45±74.91μg/L vs182.01±79.90μg/L, P>0.05) orleflunomide group232.79±66.68μg/L vs234.28±62.00μg/L, P>0.05).2.3The correlation between HCY, ADP and clinical parameters2.3.1The serum level of HCY in RA group was positively correlated withCRP (r=0.570, P=0.001), while there was no significant correlation with BMI,DAS28, ESR, RF, PLT. The serum level of ADP was positively correlated withHDL-C (r=0.548, P=0.002), while negative with DAS28(r=﹣0.586，P=0.001) and CRP (r=﹣0.402, P=0.028).2.3.2There was no significant correlation between serum HCY and ADP levelin RA group (r=0.003, P=0.986).Conclusions:1. There were high level HCY and low level ADP in RA, and similar to DMcontrols. The study suggests the risk of CVD in RA increase, and the riskof CVD of RA patients may be equivalent to DM patients.2. The serum levels of HCY and ADP were related with disease activity ofRA, which suggests the risk of CVD may be decrease through controllingdisease activity.3. The serum level of HCY was higher after the treatment with methotrexate.The elevated serum HCY and ADP levels may be a predictor for CVD inparients with rheumatoid arthirits. The study suggests it is necessary toprescribe folic acid while management with MTX. The serum level ofHCY had no significant change after the treatment with leflunomide. The study suggests that LEF is better than MTX in the influence to the risk ofCVD of RA.