AB0293 ASSOCIATION OF HOMOCYSTEINE WITH BONE MINERAL DENSITY IN RHEUMATOID ARTHRITIS PATIENTS
Authors: Antonio Alvarez de Cienfuegos, Lucia Cantero-Nieto, José Alberto García-Gómez, Jose Luis Callejas-Rubio, Miguel A. González-Gay, Norberto Ortego
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease with unknown etiology that primarily affects the peripheral joints and, over time, leads to loss of mobility if untreated. RA is an important risk factor of osteoporosis and occurrence of fractures. Many authors describe a significantly higher frequency of osteoporosis and fractures in patients with RA in comparison to a control group. The aetiology of progressive bone mass loss in RA patients is multi-factorial and remains obscure. Factors related to the pathological process – activity of RA and applied therapy – seem to be significant. Homocysteine (Hcy) is a sulfhydryl containing amino acid produced by demethylation of an essential amino acid (methionine). A high serum level of Hcy has been recently recognized as a risk factor for osteoporosis and osteoporotic fractures in postmenopausal women. <h3>Objectives</h3> The purpose of this study was to evaluate serum Hcy levels in RA patients compared with healthy controls, examine possible associations between Hcy and bone mineral density. <h3>Methods</h3> This cross-sectional study was performed in Vega-Baja Hospital, Orihuela (Spain) from November 2016 to May 2018. We prospectively enrolled 63 consecutive women patients affected by RA and followed at the Vega-Baja Hospital (Orihuela, Spain) and 60 matched healthy women controls. All patients included in this study had normal serum creatinine (Cr) levels and met the 2010 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for RA. Serum Hcy was analyzed using immunonephelometric method. Bone mineral density (BMD) of femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DXA). <h3>Results</h3> A total of 63 female patients were included in our study, with a mean (SD) age of 53 ± 8 years. The majority were Caucasian (90.5%). Thirty-four patients were menopausal and twenty-nine non-menopausal patients. The mean duration of RA was 8.5 ± 5.8 years. The mean disease activity scores in 28 joints (DAS28) according to the erythrocyte sedimentation rate (ESR) indicated low disease activity 3.0 ± 1.3. The mean health assessment questionnaire (HAQ) was 0.75 ± 0.67. Twenty-eight patients were treated with methotrexate, with a median weekly dose of 11.5 ± 4.8 mg, all the patients received 10 mg folic acid supplementation per week. Serum Hcy concentrations were significantly higher in the RA patients than those in the control group: [9.93 (5.6-18.8) vs. 7.11 (4.9-11.1), pg/mL; <i>P</i>&lt;0.001]. Serum levels of Hcy were inversely related to lumbar spine BMD and femur neck BMD (r -0.28; <i>P</i> &lt; 0.05). <h3>Conclusion</h3> Patients with RA have high levels of Hcy that correlate, inversely, with bone mass suggesting that hyperhomocysteinemia is a risk factor for osteoporosis in patients with RA. <h3>References</h3> [1] Kim SY, Schneeweiss S, Liu J, Daniel GW, Chang CL, Garneau K, Solomon DH. Risk of osteoporotic fracture in a large population-based cohort of patients with rheumatoid arthritis. Arthritis Res Ther. 2010; 12: 154–164. [2] Macovei L, Ancuta C, Belibou C, Chirieac R. Bone mineral density in patients with rheumatoid arthritis. Rev Med Chir Soc Med Nat Iasi. 2011; 115 (3): 723–730. [3] Gjesdal CG, Vollset SE, Ueland PM, Refsum H, Drevon CA, Gjessing HK, Tell GS. Plasma total homocysteine level and bone mineral density: the Hordaland Homocysteine Study. Arch Intern Med. 2006; 166:88-94. [4] Bucciarelli P, Martini G, Martinelli I, et al. The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women. Eur J Intern Med. 2010; 21:301-305. <h3>Disclosure of Interests</h3> Antonio Alvarez de Cienfuegos : None declared, Lucia Cantero-Nieto: None declared, José Alberto García-Gómez: None declared, Jose Luis Callejas-Rubio: None declared, Miguel A González-Gay Grant/research support from: Prof. MA Gonzalez-Gay received grants/research supports from Abbvie, MSD, Jansen and Roche., Speakers bureau: Consultation fees/participation in company sponsored speaker's bureau from Pfizer, Lilly, Sobi, Celgene, Novartis, Roche and Sanofi., Norberto Ortego: None declared