THU0282 Homocysteine: any role in peripheral vascular disease in systemic lupus erythematosus (SLE) patients?
Authors: N Mohannad, M Tayel, MH Megallaa
Journal: Annals of the Rheumatic Diseases (2017)

<h3>Background</h3> Many are the independent risk factors for premature atherosclerosis in general &amp; peripheral vascular disease (PVD) in particular in SLE patients. Plasma homocysteine (HCY) is a known risk factor for atherosclerosis. Atherosclerosis can lead to many cardiovascular diseases as myocardial infarction, stroke and claudication <h3>Objectives</h3> To compare the occurrence PVD of the lower extremity of SLE patients (pts) with age and sex matched controls and evaluate the role of HCY level in its occurrence <h3>Methods</h3> Body mass index (BMI), blood pressure, lipid profile, titers of autoantibodies [ANA, anticardiolipin antibodies ACL (IgM, IgG)], C3, C4, plasma HCY level were assessed, SLEDAI and (SLICC/ACRDI)were calculated. PVD evaluation was done by measuring Ankle Brachial Index (ABI) with values &lt;0.9 considered diagnostic of PVD; in 60 SLE pts and 30 age-matched controls. Patients with previous hypertension, diabetes, other collagenic diseases &amp; smokers were excluded <h3>Results</h3> Eighty-eight percent of the pts were women. The mean age (SD) was 30.40 (11.46) years &amp; mean disease duration 3.61 (4.92)years. 50 pts were asymptomatic, 5 had mild &amp; 5 had moderate claudications.SLE pts had significant higher total cholesterol (TC), LDL than controls 224.1±57.8 vs 181.1±41.1 mg/dl &amp; 162.7±57.0 vs 119.5±13.4 (&lt;0.001*) respectively, higher HCY 11.6±2.1 &amp; 6.4±0.1 μmol/L (p&lt;0.001*) &amp; lower HDL 47.2±13.1 &amp;52.6±3.7 mg/dl (p=0.004*). Low ABI was found in 30% of SLE pts but none of the controls (p=0.001*) &amp; was correlated with higher HCY level (p=0.005*), TC &amp; LDL (p&lt;0.001* &amp; p&lt;0.001*), but not TG (p=0.748) or asymptomatic pts, presence of mild or moderate claudications (p=0.468,1.000, 0.154), still its value negatively correlated with lupus anticoagulant (LA) (p=0.002), ACL IgM (p&lt;0.001*), the presence of lupus nephritis (LN) (p&lt;0.001*) &amp; SLICC/ACRDI (p=0.017*) but not with disease duration (dd) (p=0.535), Anti ds DNA (p=0.364), ACL IgG (p=0.8940), C4 (p=0.168) or SLEDAI (p=0.074).No correlation was found between HCY level and pts9 age, dd, age at diagnosis, BMI, Anti ds DNA, ACL IgG, C4 &amp; SLEDAI (p=0.521, 0.098, 0.946, 0.502, 0.346, 0.335, 0.325, 0.787). A positive correlation was found between HCY level and LA, ACL IgM, TC, LDL, the presence of LN &amp; SLICC/ACRDI with a p value of 0.025*, &lt;0.001*, &lt;0.001*, 0.003*, 0.001*, 0.001* &amp; negative one with HDL p=0.023* <h3>Conclusions</h3> 83.3% of SLE pts were asymptomatic or had atypical symptoms of PVD still 30% of the patients had low ABI. ABI can be a more reliable, non-invasive test to assess PVD than the conventional methods of pulse palpation or history of claudication in SLE pts.Both traditional &amp; nontraditional risk factors of atherosclerosis are important but HCY can play a role, among other factors, as independent risk factor of PVD in SLE <h3>References</h3> Rayford R et al. PVD in SLE Patients. J Clin Rheum. 2013; 7:367–70. <h3>Disclosure of Interest</h3> None declared