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Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort

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Abstract

Objective

To determine the impact of homocysteine levels on damage accrual in systemic lupus erythematosus (SLE) patients.

Methods

This longitudinal study was conducted in consecutive patients seen every 6 months at our Rheumatology Department since 2012. Patients with available homocysteine levels and who had at least one subsequent visit were included. Univariable and multivariable Cox regression models were done to determine if homocysteine levels were predictive of damage accrual as per the SLICC Damage Index (SDI). The multivariable model was adjusted for pertinent variables (age at diagnosis, gender, socioeconomic status, disease duration, disease activity (SLEDAI), Framingham score, antimalarial and immunosuppressive drug use, average daily dose, and exposure time to prednisone (PDN)).

Results

One hundred forty-five patients were included; their mean (SD) age at diagnosis was 43.70 (12.09) years, 136 (93.8%) were female, and nearly all were Mestizo. At baseline, disease duration was 7.55 (6.73) years; patients were followed for 3.54 (1.27) years. The SLEDAI was 5.60 (4.34), and the SDI 0.97 (1.35). The average daily PDN dose was 7.30 (5.78) mg/day and the time of PDN exposure was 7.36 (6.73) years. Mean homocysteine levels were 10.07 (3.71) μmol/L. The highest tertile of homocysteine levels predicted new damage accrual in the univariable and multivariable models [HR 1.78 (95% CI, 1.042–3.039); p = 0.035 and HR 2.045 (95% CI, 1.077–3.883); p = 0.029, respectively]. Increased levels (> 15 μmol/L) were found in 12 (8.3%) patients; 75 (51.7%) patients increased ≥ 1 SDI point.

Conclusion

In SLE patients, homocysteine levels predicted damage accrual independently of other well-known risk factors for such occurrence.

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Change history

  • 29 April 2019

    The affiliations of <Emphasis Type="Bold">Manuel F. Ugarte-Gil,</Emphasis> one of the author of the above article has a discrepancy between the online version of the publisher’s internet portal (<ExternalRef><RefSource>Springerlink.com</RefSource><RefTarget Address="http://springerlink.com" TargetType="URL"/></ExternalRef>) and the online pdf version.

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Funding

The Almenara Lupus Cohort is partially supported by three institutional grants from EsSalud (1483-GCGP-ESSALUD-2013, 1733-GCGP-ESSALUD-2014 and the 2015 Kaelin Prize 2015) and one from the Panamerican League of Associations for Rheumatology (PANLAR) (2015 PANLAR Prize).

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Authors and Affiliations

  1. Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, Lima, Peru

    Paola A. Zeña-Huancas, Rocío V. Gamboa-Cárdenas, Cristina Reátegui-Sokolova, Francisco Zevallos-Miranda, Mariela Medina-Chinchon, Victor R. Pimentel-Quiroz, Claudia Elera-Fitzcarrald, Omar Sarmiento-Velasquez, Jorge M. Cucho-Venegas, José L. Alfaro-Lozano, Zoila J. Rodríguez-Bellido, César A. Pastor-Asurza, Risto A. Perich-Campos & Manuel F. Ugarte-Gil

  2. Hematology Service, Clinical Pathology Department, Hospital Guillermo Almenara Irigoyen - EsSalud, Lima, Peru

    Haydee Iparraguirre-López

  3. School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru

    Rocío V. Gamboa-Cárdenas, Zoila J. Rodríguez-Bellido, César A. Pastor-Asurza & Risto A. Perich-Campos

  4. Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru

    Cristina Reátegui-Sokolova

  5. School of Medicine, Universidad Científica del Sur, Lima, Peru

    Claudia Elera-Fitzcarrald

  6. School of Medicine, The University of Alabama, Birmingham, USA

    Graciela S. Alarcón & Manuel F. Ugarte-Gil

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  1. Paola A. Zeña-Huancas
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Contributions

All authors were involved in drafting or critically revising this manuscript for important intellectual content, and all authors approved the final version to be published. Drs. Paola A. Zeña Huancas and Manuel F. Ugarte-Gil have full access to all the study’s data and take responsibility for their integrity and the accuracy of the analyses performed.

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Correspondence to Paola A. Zeña-Huancas.

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Zeña-Huancas, P.A., Iparraguirre-López, H., Gamboa-Cárdenas, R.V. et al. Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort. Clin Rheumatol 38, 1139–1146 (2019). https://doi.org/10.1007/s10067-018-4389-3

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