Association of Serum Homocysteine Level and Interstitial Lung Disease in Systemic Sclerosis: A Case-control Study

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Abstract

Background: Systemic sclerosis is a disorder of connective tissue with unknown cause, affecting the skin and internal organs, characterized by fibrotic changes.

Objective: To determine the correlation between serum homocysteine level and interstitial lung involvement in systemic sclerosis.

Materials and Methods: In this case – control study, 59 patients who fulfilled the ACR/EULAR classification criteria for systemic sclerosis and were referred to Hafez Hospital of Shiraz, Iran, were included as the case group. Fifty nine healthy subjects were involved as the control group. Patients were divided into two groups based on interstitial lung involvement and two subtypes, diffuse and limited type. Serum homocysteine, vitamin B12, and folate levels compared between the controls, and cases groups.

Results: Of 59 case and control group, 53 (%89.8) were female and the mean age did not differ in both groups (P=0.929). Thirty five (%59.3) patients had interstitial lung involvement and 38(%64.4) had diffuse cutaneous systemic sclerosis. The mean serum homocysteine level was 13.9±6.3 µmol/L in the case and 13.7±9.2 µmol/L in the control group (P=0.86). The mean serum homocysteine level did not differ between the patients with and without interstitial lung involvement (P=0.52). The patients with lung involvement was older than those without lung involvement (P=0.004). Lung disease was more common in diffuse type (P=0.014).

Conclusion: In our study, serum homocysteine level did not differ between the patients and healthy subjects. Also, there was no correlation between serum homocysteine level and lung involvement, but lung involvement was more common in older patients and also diffuse subtype.

Keywords: Serum homocysteine, systemic sclerosis, interstitial lung disease, connective tissue, skin, internal organs.

Graphical Abstract

[1]
Zhang Y-J, Zhang L, Huang X-L, Duan Y, Yang L-J, Wang J. Association between cigarette smoking and impaired clinical symptoms in systemic sclerosis: A review. Cell Immunol 2017; 318: 1-7.
[2]
Hax V, Bredemeier M, Moro ALD, et al. Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis. Semin Arthritis Rheum 2017; 47(2): 228-34.
[3]
LeRoy EC, Black C, Fleischmajer R, et al. Scleroderma (systemic sclerosis): Classification, subsets and pathogenesis. J Rheumatol 1988; 15(2): 202-5.
[4]
Derk CT, Jimenez SA. Systemic sclerosis: Current views of its pathogenesis. Autoimmun Rev 2003; 2(4): 181-91.
[5]
Selhub J. Homocysteine metabolism. Annu Rev Nutr 1999; 19: 217-46.
[6]
Stanger O, Herrmann W, Pietrzik K, et al. Clinical use and rational management of homocysteine, folic acid, and B vitamins in cardiovascular and thrombotic diseases. Zeitschrift fur Kardiologie 2004; 93(6): 439-53.
[7]
Szamosi S, Csiki Z, Szomjak E, et al. Plasma homocysteine levels, the prevalence of methylenetetrahy drofolate reductase gene C677T polymorphism and macrovascular disorders in systemic sclerosis: Risk factors for accelerated macrovascular damage? Clin Rev Allergy Immunol 2009; 36(2-3): 145-9.
[8]
Cheng TT, Lai HM, Chang HW, Luo SF. Elevated serum homocysteine levels for gouty patients. Clin Rheumatol 2005; 24(2): 103-6.
[9]
Refai TM, Al-Salem IH, Nkansa-Dwamena D, Al-Salem MH. Hyperhomocysteinaemia and risk of thrombosis in systemic lupus erythematosus patients. Clin Rheumatol 2002; 21(6): 457-61.
[10]
Roubenoff R, Dellaripa P, Nadeau MR, et al. Abnormal homocysteine metabolism in rheumatoid arthritis. Arthritis Rheum 1997; 40(4): 718-22.
[11]
Caramaschi P, Volpe A, Canestrini S, et al. Correlation between homocysteine plasma levels and nailfold videocapillaroscopic patterns in systemic sclerosis. Clin Rheumatol 2007; 26(6): 902-7.
[12]
Caramaschi P, Martinelli N, Biasi D, et al. Homocysteine plasma concentration is related to severity of lung impairment in scleroderma. J Rheumatol 2003; 30(2): 298-304.
[13]
Baskan BM, Sivas F, Aktekin LA, Dogan YP, Ozoran K, Bodur H. Serum homocysteine level in patients with ankylosing spondylitis. Rheumatol Int 2009; 29(12): 1435-9.
[14]
Jacomella V, Wasila M, Husmann M, Gitzelmann G, Meier T, Amann-Vesti B. Plasma homocysteine is not related to the severity of microangiopathy in secondary raynaud phenomenon. Open Rheumatol J 2011; 5: 64-8.
[15]
Nazarinia M, Shams M, Kamali Sarvestani E, Shenavande S, Khademalhosseini M, Khademalhosseini Z. Serum homocystein level in patients with scleroderma. Iran Red Crescent Med J 2013; 15(1): 29-31.
[16]
Zhang Y-J, Zhang L, Huang X-L, Duan Y, Yang L-J, Wang J. The association between homocysteine and systemic sclerosis: A review of the literature and meta-analysis. Mod Rheumatol 2018; 28(4): 681-9.
[17]
Vayá A, Sánchez F, Todolí J, et al. Homocysteine levels in patients with primary and secondary Raynaud’s phenomenon. Its association with microangiopathy severity. Clin Hemorheol Microcirc 2014; 56(2): 153-9.
[18]
Papp J, Sandor B, Toth A, et al. Altered microrheological parameters in Raynaud’s phenomenon. Clin Hemorheol Microcirc 2017; 65(1): 23-9.
[19]
Firestein GS, Budd R, Gabriel SE, McInnes IB, O'Dell JR. Kelley and Firestein's Textbook of Rheumatology E-Book: Elsevier Health Sciences; 2016 Jun 21.
[20]
Marasini B, Massarotti M, Biondi ML. Homocysteine and vascular diseases. Circulation 2002; 106(7): e33.