Session Information
Date: Tuesday, November 15, 2016
Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Hyperhomocysteinemia has been correlated with the occurrence of blood clots, heart attacks and strokes. We investigated the association of the Hyperhomocysteinemia with other clinical and laboratory manifestations, in particular with urine protein/creatinine ratio.
Methods: 829 patients with at least one homocysteine measurement since 2014 were included in the analysis. Patients were followed quarterly after cohort entry.
Results: 762 (91.9%) were female. Majority (48.4%) were Caucasian, 42.1% African American. For the first homocysteine measurement, 79.4% were below 15 umol/L. The association of Hyperhomocysteinemia with other clinical and laboratory manifestations is shown in Table 1 and association with organ damage is shown in table 2. Table 1 the association between homocysteine and SLE manifestation, adjusting for ethnicity and sex (Statistically Significant Result Highlighted)
| |
Homocysteine > = 15 umol/L (%) | Homocysteine < 15 umol/L (%) | Odd ratios (95% CI) | P value | Adj. Odd ratios (95% CI) | Adj. P value | |
| Malar rash |
44.14 |
44.35 |
0.99 (0.66,1.48) |
0.9674 |
1.12 (0.74,1.7) |
0.5812 |
|
| Discoid rash |
23.64 |
19.67 |
1.26 (0.78,2.04) |
0.3349 |
1.08 (0.66,1.78) |
0.7583 |
|
| Photosensitivity |
45.05 |
51.32 |
0.78 (0.52,1.16) |
0.2190 |
0.91 (0.6,1.37) |
0.6433 |
|
| Oral/Nasal Ulcers |
46.85 |
54.81 |
0.73 (0.49,1.08) |
0.1183 |
0.84 (0.56,1.27) |
0.4155 |
|
| Arthritis |
65.77 |
69.27 |
0.85 (0.56,1.3) |
0.4583 |
0.79 (0.52,1.22) |
0.2909 |
|
| Serositis | Pleurisy |
36.04 |
44.01 |
0.72 (0.47,1.08) |
0.1153 |
0.69 (0.45,1.05) |
0.0807 |
| Pericarditis |
21.62 |
22.91 |
0.93 (0.57,1.51) |
0.7641 |
0.82 (0.5,1.34) |
0.4270 |
|
| Renal disorder |
11.11 |
2.93 |
4.14 (1.97,8.68) |
0.0002 |
4.48 (2.1,9.55) |
0.0001 |
|
| Neurologic | Seizures |
11.71 |
6.55 |
1.89 (0.99,3.63) |
0.0541 |
1.81 (0.94,3.51) |
0.0778 |
| Acute confusional state |
5.41 |
2.23 |
2.51 (0.96,6.55) |
0.0607 |
2.44 (0.91,6.51) |
0.0760 |
|
| Hematologic | Hemolytic anemia |
11.82 |
7.41 |
1.67 (0.88,3.18) |
0.1163 |
1.69 (0.88,3.25) |
0.1150 |
| Leukopenia |
53.15 |
51.39 |
1.07 (0.72,1.6) |
0.7298 |
1.04 (0.69,1.57) |
0.8431 |
|
| Lymphopenia |
46.85 |
44.77 |
1.09 (0.73,1.62) |
0.6824 |
1.06 (0.71,1.59) |
0.7743 |
|
| Thrombocytopenia |
17.12 |
18.99 |
0.88 (0.52,1.49) |
0.6374 |
0.89 (0.52,1.52) |
0.6727 |
|
| Immunologic | Anti-dsDNA |
55.86 |
63.74 |
0.72 (0.48,1.08) |
0.1112 |
0.68 (0.45,1.03) |
0.0678 |
| Anti Sm |
29.09 |
22.63 |
1.4 (0.9,2.19) |
0.1378 |
1.24 (0.78,1.97) |
0.3720 |
|
| Anti- phospholipid | Anti-cardiolipin |
43.24 |
57.62 |
0.56 (0.37,0.84) |
0.0049 |
0.54 (0.36,0.81) |
0.0033 |
| Anti- B2 Gly |
16.98 |
29.69 |
0.48 (0.28,0.82) |
0.0076 |
0.46 (0.27,0.8) |
0.0054 |
|
| False positive RPR |
9.52 |
11.33 |
0.82 (0.41,1.65) |
0.5826 |
0.85 (0.42,1.71) |
0.6525 |
|
| LAC |
19.82 |
29.29 |
0.6 (0.36,0.98) |
0.0404 |
0.54 (0.33,0.91) |
0.0190 |
|
| ANA |
95.5 |
97.21 |
0.61 (0.22,1.65) |
0.3291 |
0.5 (0.18,1.39) |
0.1856 |
Table 2 the association between homocysteine and organ damage, adjusting for ethnicity and sex (Statistically Significant Result Highlighted)
| DAMAGE COMPONENT | Homocysteine >= 15 umol/L (%) | Homocysteine < 15 umol/L (%) | Odd ratios (95% CI) | P value | Adj. Odd ratios (95% CI) | Adj. P value |
| Cataract |
28.18 |
19.61 |
1.61 (1.02,2.53) |
0.0404 |
1.67 (1.05,2.65) |
0.0305 |
| Retinal changes |
1.82 |
4.07 |
0.44 (0.1,1.86) |
0.2619 |
0.46 (0.11,1.96) |
0.2934 |
| Cognitive impairment |
8.18 |
6.56 |
1.27 (0.6,2.67) |
0.5281 |
1.29 (0.61,2.74) |
0.5046 |
| Seizure |
4.55 |
4.04 |
1.13 (0.43,2.98) |
0.8055 |
1.15 (0.43,3.09) |
0.7775 |
| Cranial or Peripheral neuropathy |
8.18 |
8.23 |
0.99 (0.48,2.07) |
0.9867 |
0.94 (0.45,1.98) |
0.8752 |
| Transverse myelitis |
0.92 |
0.14 |
6.63 (0.41,106.78) |
0.1822 |
7.28 (0.44,120.39) |
0.1656 |
| GFR <50 |
14.55 |
2.51 |
6.61 (3.26,13.4) | <.0001 | 6.54 (3.13,13.63) | <.0001 |
| Proteinuria |
18.35 |
5.44 |
3.91 (2.18,7) | <.0001 | 4.09 (2.23,7.52) | <.0001 |
| Pulmonary hypertension |
7.34 |
4.75 |
1.59 (0.72,3.53) |
0.2555 |
1.8 (0.8,4.04) |
0.1549 |
| Pulmonary fibrosis |
12.84 |
9.34 |
1.43 (0.77,2.64) |
0.2545 |
1.55 (0.83,2.9) |
0.1685 |
| Shrinking lung |
0.92 |
0.7 |
1.31 (0.15,11.33) |
0.8055 |
1.73 (0.2,15.25) |
0.6206 |
| Pleural fibrosis |
2.73 |
4.34 |
0.62 (0.19,2.06) |
0.4324 |
0.6 (0.18,2.01) |
0.4050 |
| Pulmonary infarction |
2.75 |
3.49 |
0.78 (0.23,2.64) |
0.6920 |
0.74 (0.21,2.55) |
0.6287 |
| Angina/ CABG |
4.59 |
1.95 |
2.41 (0.85,6.84) |
0.0973 |
2.04 (0.71,5.91) |
0.1868 |
| Cardiomyopathy |
4.59 |
2.09 |
2.25 (0.8,6.31) |
0.1245 |
2.34 (0.82,6.7) |
0.1120 |
| Valvular heart disease |
2.75 |
2.09 |
1.32 (0.38,4.65) |
0.6610 |
1.29 (0.36,4.61) |
0.6997 |
| Pericarditis/ pericardectomy |
1.82 |
1.12 |
1.64 (0.34,7.83) |
0.5343 |
1.53 (0.31,7.5) |
0.5994 |
| Claudication |
5.45 |
3.07 |
1.82 (0.72,4.6) |
0.2039 |
1.64 (0.63,4.24) |
0.3087 |
| DVT |
2.73 |
0.98 |
2.84 (0.72,11.17) |
0.1342 |
2.92 (0.73,11.63) |
0.1285 |
| Upper GI surgery |
1.8 |
1.4 |
1.29 (0.28,5.98) |
0.7418 |
1.29 (0.27,6.07) |
0.7513 |
| Muscular atrophy/ weakness |
8.49 |
5.82 |
1.5 (0.71,3.18) |
0.2905 |
1.52 (0.71,3.27) |
0.2835 |
| Osteoporosis |
13.51 |
15.38 |
0.86 (0.48,1.54) |
0.6091 |
0.94 (0.52,1.71) |
0.8510 |
| Alopecia |
7.34 |
4.89 |
1.54 (0.7,3.42) |
0.2869 |
1.33 (0.59,3.01) |
0.4905 |
| Scarring of panniculum |
2.73 |
2.09 |
1.31 (0.37,4.6) |
0.6733 |
1.11 (0.31,3.98) |
0.8731 |
| Skin ulceration |
0.91 |
0.84 |
1.09 (0.13,9.1) |
0.9396 |
1.21 (0.14,10.25) |
0.8634 |
| Premature gonadal failure |
7.27 |
4.62 |
1.62 (0.73,3.6) |
0.2381 |
2.06 (0.91,4.67) |
0.0844 |
| Diabetes |
9.09 |
5.74 |
1.64 (0.8,3.38) |
0.1788 |
1.64 (0.79,3.42) |
0.1839 |
| HTN |
59.63 |
27.16 |
3.96 (2.61,6.01) | <.0001 | 3.65 (2.37,5.6) | <.0001 |
Among 829 patients, 604 have at least two homocysteine measurements, 272 have three or more. To account for correlations of measurement within patients, we used GEE model to estimate the association between homocysteine and urine protein creatinine ratio using serial tests of homocysteine. A 10 umol/L decrease in Homocysteine within a person corresponds to an average 0.011 (95% CI: 0.006 to 0.015) unit decrease in urine protein/creatinine ratio (P < 0.0001), after adjusting for sex and ethnicity. The association remains significant (0.004 (95% CI 0.002 to 0.007), P = 0.0005) when only including patients with first homocysteine greater or equal to 15 umol/L and corresponding urine protein creatinine ratio greater or equal to 0.2
Conclusion: homocysteine is showed to be strongly correlated with renal disorder, low GFR and proteinuria. Decreased homocysteine might also indicates improved renal functionality.
To cite this abstract in AMA style:
Petri M, Fu W. Hyperhomocysteinemia in SLE [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/hyperhomocysteinemia-in-sle/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/hyperhomocysteinemia-in-sle/