Source: Endocrinology  |  Posted 8 years ago

In patients with rheumatoid arthritis (RA), treatment with B-vitamins can reduce homocysteine levels, which appear to be related to markers of inflammation and methotrexate treatment (MTX), according to the findings of a new study.

The metabolism of homocysteine is dependent on the vitamins B6, B12, and folate. An increased intake of these vitamins, especially folate, is believed to reduce homocysteine levels in most individuals. However, the impact of B vitamins on homocysteine levels in RA patients is unclear.

A. Yxfeldt, MD, with the Department of Rheumatology at the University Hospital, in Umea, Sweden, and colleagues investigated the effects of treatment with B vitamins on homocysteine levels in 62 patients with RA and levels of homocysteine of at least 12 micromol/L.

Participants were randomised to receive placebo or a combination of vitamins B6, B12, and folic acid, and were treated and evaluated in a double-blind manner over 12 months.

Homocysteine levels decreased significantly in the B-vitamin-treated patients compared with the placebo-treated patients, the researchers report.

A simple regression model found that the homocysteine level at inclusion was associated with IL-2sR alpha. In addition, a multiple regression model showed an association between the alteration in homocysteine level over 12 months and MTX treatment, as well as the alteration in C-reactive protein, adjusted for B-vitamin treatment.

"Our results indicate that the homocysteine levels in patients with stable RA are as easy to reduce as the homocysteine levels among the general population," Dr. Yxfeldt and colleagues note.

They also point out that MTX treatment and the inflammatory activity appear to influence homocysteine levels in RA. "However, this study was small and none of the patients studied had a particularly high inflammatory activity, so this hypothesis needs further analysis," they add.