ABSTRACT
The aim of the present work is to assess total homocysteine level [tHcy] in rheumatoid arthritis [RA] patients and its relation to the presence of coronary atherosclerosis and endothelial dysfunction. Subjects and 20 female patients with rheumatoid arthritis and 10 healthy control subjects matched for age and sex were subjected to estimation of total plasma homocysteine concentration by high performance liquid chromatography and fluroscent detection, and von Willebrand factor [vWF], a reliable marker of endothelial cell dysfunction using ELISA technique. Intimal-medial thickness, peak systolic and diastolic velocities in the common carotid artery were measured using Duplex ultrasound, and resistance index was calculated. The results revealed significant increase in total homocysteine level in rheumatoid patients as compared to normal controls [31.33 +/- 14.4 versus 12.5 +/- 2.08, P<0.05] with no significant difference between patients with ischaemic heart disease and without. Also, von Willebr and factor was significantly higher in patients as compared to controls [2.01 +/- 0.5 versus 1.5 +/- 0.3, P<0.05] with positive correlation between homocysteine level and vWF [r=0.881]. Duplex ultrasound evaluation demonstrated mean intima-media thickness wich was significantly greater in RA patients as compared to the control group [0.63 +/- 0.1 versus 0.3+0.6, P<0.05] and positively associated with [tHcy] level [r=0.836310] with high resistance index [62.6 +/- 19.48]. Conclusions: RA patients have fasting hyperhomocysteinemia, which may be a marker for premature atherosclerosis and endothelial dysfunction. Further studies are needed to determine the clinical impact of homocysteine lowering therapy