Homocysteine levels in patients with Behçet's disease and patients with recurrent aphthous stomatitis

Plasma Homocysteine in Behcet's Disease: A Systematic Review and Meta-Analysis

AIM

 To evaluate the relevance of plasma homocysteine (HC) in Behcet's disease (BD) and its clinical manifestations.

METHODS

 Systematic review of EMBASE and PubMed databases according to PRISMA guidelines from inception to July 2021; random-effects meta-analyses for continuous outcomes.

RESULTS

 The search strategy retrieved 48 case-control (2,669 BD and 2,245 control participants) and 5 cohort studies (708 BD participants). Plasma HC was higher in BD than in controls (p < 0.0001) with wide heterogeneity (I2  = 89.7%) that remained unchanged after sensitivity analysis according to year of article publication, age of BD participants, study size, study quality, method of HC determination, and male/female ratio >1.5; some pooled ethnicities explained a small part of the heterogeneity (I2  = 16.3%). Active BD participants had higher HC than inactive ones (p < 0.0001), with moderate heterogeneity (I2  = 49.2%) that disappeared after removal of an outlier study with very high disease activity. BD participants with any vascular involvement had higher HC than those without (p < 0.0001) with wide heterogeneity (I2  = 89.7%); subgroup analysis on venous thrombosis only changed neither effect size (p < 0.0001) nor heterogeneity (I2  = 72.7%). BD participants with ocular involvement had higher HC than those without (p < 0.0001) with moderate heterogeneity (I2  = 40.3%).

CONCLUSION

 Although causality cannot be inferred, the consistency of the elevation of plasma HC in BD, particularly in patients with active disease, with vascular and ocular involvement suggests an intrinsic involvement of HC in these clinical manifestations.

Impact of haematologic deficiencies on recurrent aphthous ulceration: a meta-analysis

BACKGROUND

Recurrent aphthous ulceration (RAU) is one of the most common oral mucosal diseases, some of which may be secondary to haematologic deficiencies. This meta-analysis aims to evaluate the association between haematologic deficiencies and RAU.

MATERIALS AND METHODS

Case control studies were identified using a predefined search strategy that compared the difference in haematologic deficiencies between a RAU group and a control group. A meta-analysis was performed to estimate the combined odds ratios (ORs) and 95% confidence intervals (95% CIs) in a fixed-effects model and a random-effects model, as appropriate.

RESULTS

In this meta-analysis, nine case control studies, including total 710 cases in RAU groups and 602 cases in control groups, were considered eligible for inclusion. Overall, the combined results based on all studies showed that the rate of haematinic deficiencies was significantly high in the RAU group (vitamin B12: OR=3.75, 95% CI: 2.38-5.94; folic acid: OR=7.55, 95% CI: 3.91-14.60; ferritin: OR=2.62, 95% CI: 1.69-4.06; and haemoglobin: OR=1.77, 95% CI: 1.12-2.80).

CONCLUSION

This meta-analysis suggests that haematologic deficiencies could be a significant risk factor for RAU. Thus, screening and treating any haematologic deficiencies may play an important role in preventing the occurrence of RAU.

Subclinical atherosclerosis in patients with recurrent aphthous stomatitis

OBJECTIVE

Recurrent aphtous stomatitis (RAS) is an inflammatory oral mucosal disease. It has been known that inflammatory cascade plays important role in the atherosclerotic process. The aim of the study was to investigate the relationship between subclinical atherosclerotic findings and a systemic inflammatory disease, RAS.

METHODS

In total, 32 patients with RAS were matched with 30 control subjects on the basis of age, sex, and major cardiovascular risk factors. Laboratory parameters including lipid profiles were determined for patients and controls. B-mode ultrasonography was used to assess carotid extra-medial thickness (cEMT) and carotid intima-media thickness (cIMT).

RESULTS

Both cEMT and cIMT in the RAS group were significantly higher than in the control group (P = 0.002 and 0.013, respectively). There was a significant positive correlation between cIMT and cEMT (r = 0.381, P = 0.034). cIMT was positively correlated with age, triglyceride levels, and systolic blood pressure, while cEMT was positively correlated with age in patients with RAS.

CONCLUSIONS

To our knowledge, this is the first reported study to evaluate cEMT and cIMT in patients with RAS. This study presents morphological evidence of subclinical atherosclerosis in patients with RAS. Further studies investigating the relationship between atherosclerosis and RAS are needed.

Evaluation of Serum Homocysteine and Leptin Levels in Patients with Uveitis

OBJECTIVES

To evaluate the serum homocysteine (Hcy) and leptin levels in patients with uveitis.

MA­TE­RI­ALS AND MET­HODS

The 70 cases included in the study comprised 3 groups: patients with Behçet's uveitis (BU), patients with non-Behçet's uveitis (NBU) and healthy controls. Body mass index was calculated for each subject. Serum Hcy and leptin levels were measured. Furthermore, acute-phase reactants including erythrocyte sedimentation rate (ESR), C-reactive protein and neutrophil count were measured.

RE­SULTS

Serum Hcy levels were 15.04±4.59 µmol/L in the BU group, 15.4±6.87 µmol/L in the NBU group and 13.64±4.72 µmol/L in the control group (p>0.05). The serum leptin levels of male patients in the BU group, NBU group and control group were 4.76±3.54 ng/ml, 6.33±3.74 ng/ml and 5.47±6.33 ng/ml, respectively (p>0.05). When we compared serum leptin levels in female patients and controls, the mean serum leptin concentrations were significantly higher in female BU and NBU patients (24.83±17.62 ng/ml and 28.46±13.90 ng/ml, respectively) than in healthy control volunteers (9.62±6.36 ng/ml, p<0.05). In addition, the ESR value differences between groups were statistically significant (p<0.05).

CONCLUSION

A larger case series is necessary to investigate serum Hcy and leptin concentrations in uveitis patients.

Markers of Endothelial Dysfunction and Evaluation of Vascular Reactivity Tests in Behçet Disease

We assessed endothelial dysfunction (ED) in patients with Behcet disease (BD; n = 40) and healthy controls (n = 20). Serum lipid, homocysteine, asymmetric dimethylarginine (ADMA) and high-sensitivity C-reactive protein (hsCRP) levels, erythrocyte sedimentation rates (ESRs), and ultrasonographic flow-mediated dilatation (FMD) were measured. Mean hsCRP, ESR, homocysteine, and ADMA were significantly higher in the BD group ( P < .001 for all). Patients with active BD had higher serum levels of hsCRP, homocysteine, and ESR compared with those in remission ( P < .001, P < .001, and P = .005, respectively). Flow-mediated dilatation was significantly lower in patients with BD than in controls ( P = .001). Flow-mediated dilatation correlated negatively with BD duration and serum ADMA levels ( P < .001, r = −.745 and P < .001, r = −.682); a positive correlation was seen between serum ADMA levels and BD duration ( P < .001, r = .552). Only stepwise multivariate regression analysis revealed BD duration to have a significant effect on FMD. Flow-mediated dilatation, in conjunction with markers of inflammation, may evaluate ED in patients with BD.

Hyperhomocysteinaemia in Behçet's Disease

Objectives. The aim of this study was to investigate if hyperhomocysteinaemia is a contributive risk factor for the pathogenesis and the activity of Behçet's disease (BD). Design and Methods. Fifty four patients fullfiling the criteria of the International Study Group for BD were enrolled. Fifty healthy volunteers matched for age and sex with the BD group were included as a negative control group. Patients, with any condition that might affect plasma homocysteine concentration, were excluded. Results. Mean serum homocysteine concentration was significantly higher in patients with BD than in the healthy controls (P < .001), in patients with active disease (P = .04), and in masculine gender (P = .05). There was no significant difference between homocysteine level and clinical involvement. Conclusions. We demonstrated that plasma total homocysteine level (tHcy) is increased in BD and correlated with disease activity. No association was found between homocysteine levels and clinical involvement.

A case of Hughes-Stovin syndrome associated with hyperhomocysteinemia

We report a case of Hughes-Stovin syndrome (HSS) associated with hyperhomocysteinemia. A 24-year-old man who has no clinical features suggestive of Behcet's disease was admitted for hemoptysis and dyspnea. Radiological and laboratory evaluation revealed multifocal pulmonary artery aneurysms involving bilateral segmental pulmonary artery, thrombi in right atrium and ventricle, and hyperhomocysteinemia. Accordingly, HSS associated with hyperhomocysteinemia was diagnosed, and the clinical and radiological improvement was achieved after treatment with prednisolone, warfarin, and folic acid.