Homocysteine levels in polymyalgia rheumatica and giant cell arteritis: influence of corticosteroid therapy

Martínez‐Taboada, Víctor M.; Bartolome, Ma. Jose; Fernández-González, María Dolores; Blanco, Ricardo; Rodríguez‐Valverde, V.; López‐Hoyos, Marcos

doi:10.1093/rheumatology/keg293

Cited by 25 publications

(15 citation statements)

References 35 publications

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“…However, patients with aortic manifestations from GCA also had a greater than expected number of deaths from ischaemic heart disease and non-ischaemic cardiac disease. Conceivably, the aortic inflammation in GCA and atherosclerosis share common pathobiological pathways which may account for our observed association 36 37. It is also possible that the underlying cause of death in patients with aortic aneurysms was dissection but was misdiagnosed as another event such as a coronary event, which is common in the elderly.…”

Section: Discussionmentioning

confidence: 74%

Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis

et al. 2012

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Objectives To evaluate incidence trends and timing of large-vessel (LV) manifestations in patients with giant cell arteritis (GCA), and, to examine the influence of LV manifestations on survival. Methods A population-based incident cohort of patients diagnosed with GCA between 1950 and 2004 was used. LV involvement was defined as large artery stenosis or aortic aneurysm/dissection that developed in the 1 year prior to GCA diagnosis or any time thereafter. Patients were followed until death or December 31, 2009. Results The study included 204 patients, 80% women, mean age at diagnosis of GCA 76.0 years (± 8.2 years). Median length of follow-up was 8.8 years. The cumulative incidence of any LV manifestation at 10 years was 24.9% for patients diagnosed with GCA between 1980–2004 compared to 8.3% for patients diagnosed with GCA between 1950 and 1979. The incidence of any LV event was high within the first year of GCA diagnosis. The incidence of aortic aneurysm/dissection increased 5 years after GCA diagnosis. Compared to the general population, survival was decreased in patients with an aortic aneurysm/dissection (p<0.001) but not in patients with large-artery stenosis (p=0.11). Patients with GCA and aortic manifestations had higher than expected number of deaths from cardiovascular and pulmonary causes compared to the general population. Among patients with GCA, aortic manifestations were associated with increased mortality (HR: 3.4; 95% CI: 2.2, 5.4). Conclusions Screening for aortic aneurysms should be considered in all patients with GCA with vigilance 5 years after incidence. Aortic aneurysm/dissection is associated with increased mortality in GCA.

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Section: Discussionmentioning

confidence: 74%

Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis

et al. 2012

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“…In patients with giant-cell arthritis, serum levels of homocysteine increased after several months of glucocorticoid treatment [25] . In contrast, serum homocysteine concentration decreased after three pulses of glucocorticoid administration in patients with rheumatoid arthritis [16] .…”

Section: Discussionmentioning

confidence: 99%

“…However, we cannot exclude that the association between cortisol and homocysteine could partially result from the simultaneous association of these two variables to some other factor not considered in the present study. Nevertheless, the increased homocystein- emia observed after prolonged glucocorticoid treatment [25] and in patients with Cushing's syndrome [14,15] indicates that sustained high serum cortisol could be a primary cause of hyperhomocysteinemia. In the present study, a negative correlation between serum concentrations of cortisol and ascorbate was observed.…”

Section: Discussionmentioning

confidence: 99%

Serum Homocysteine: Relationship with Circulating Levels of Cortisol and Ascorbate

et al. 2008

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Background/Aim: High serum levels of homocysteine and cortisol are independent risk factors for several pathologies and their levels can be regulated by some vitamins. Since the relationship between serum concentrations of homocysteine, cortisol and ascorbate has not been assessed in healthy individuals to date, it was the topic of the present work. Methods: The study group was composed of 20 men and 40 women aged >50 years. Blood samples were collected and serum concentrations of the analytes were quantified. Results: Serum homocysteine levels correlate positively with cortisol (r = 0.36, p <0.01) and age (r = 0.49, p < 0.001), and negatively with ascorbate (r = –0.30, p < 0.05) and folate (r = –0.31, p < 0.05). A negative correlation between serum levels of cortisol and ascorbate (r = –0.30, p < 0.05) was also observed. Multiple linear regression analysis showed that the best independent predictors of serum homocysteine concentration were cortisol (β = 0.319, p < 0.003), age (β = 0.529, p < 0.001) and folate (β = –0.338, p < 0.001). When subjects were divided into tertiles according to their homocysteine concentration, the highest tertile of homocysteine concentration has also higher cortisol (p < 0.005) and lower ascorbate (p < 0.05) concentrations compared with the lowest tertile of homocysteine concentration. Conclusion: The association between serum concentrations of homocysteine, cortisol and ascorbate suggests interaction between circulating levels of these molecules.

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“…Homocysteine levels were evaluated in only 1 report of 17 GCA and 39 polymyalgia rheumatica patients 27 . Plasma levels were significantly higher in GCA-polymyalgia rheumatica patients compared to age-matched controls.…”

Section: Homocysteine Levelsmentioning

confidence: 99%

Risk Factors for Cranial Ischemic Complications in Giant Cell Arteritis

Nesher

Berkun²,

Mates³

et al. 2004

Medicine

133

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Cranial ischemic complications (CICs) are among the presenting manifestations of giant cell arteritis (GCA). Yet patients with GCA may develop CICs at a later stage, despite steroid therapy. In the current report we delineate risk factors for CICs, both at presentation and during follow-up, and review the relevant literature. We reviewed charts of 175 patients with GCA. Follow-up data were available for 166 patients. CICs at presentation or developing within 2 weeks of GCA diagnosis were considered GCA related. CICs developing later were considered GCA related only when associated with other GCA-related manifestations or acute-phase reactions. Associations between CICs and other variables were tested by multivariate analysis. At presentation, 43 patients (24.6%) had CICs. Risk factors were transient cerebro-ophthalmic ischemic episodes (COIEs) (odds ratio [OR] 4.3) and male sex (OR 2.5), while the presence of systemic symptoms was "protective" (OR 0.3). During follow-up 8.4% of patients with GCA developed new CICs. Risk factors in these cases were previous CICs at presentation (OR 5.6) and transient COIEs developing during follow-up (OR 14.8). The use of low-dose aspirin was protective (OR 0.2). These data, together with data from the literature review, suggest that GCA patients with transient COIEs and without fever or other systemic symptoms are at increased risk of presenting with CICs. Risk factors for late-developing CICs were CICs at presentation and late-developing transient COIEs.

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Homocysteine levels in polymyalgia rheumatica and giant cell arteritis: influence of corticosteroid therapy

Cited by 25 publications

References 35 publications

Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis

Large-vessel involvement in giant cell arteritis: a population-based cohort study of the incidence-trends and prognosis

Serum Homocysteine: Relationship with Circulating Levels of Cortisol and Ascorbate

Risk Factors for Cranial Ischemic Complications in Giant Cell Arteritis

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