Homocysteine in patients with rheumatoid arthritis in relation to inflammation and B-vitamin treatment

Objectives: To investigate the effects of treatment with B vitamins on homocysteine (Hcy) levels in patients with RA, and to analyse the relationship between Hcy levels and inflammatory variables, and/or MTX treatment. Methods: Sixty-two patients with RA and levels of Hcy greater than or equal to 12 mmol/L were randomized to receive placebo or a combination of vitamins B6, B12 and folic acid. The patients were treated and evaluated in a double-blind manner over 12 months. Results: The Hcy level decreased significantly in the B-vitamin treated patients compared with the placebo treated patients. In a simple regression model, the Hcy level at inclusion was associated with IL-2sRalpha. In a multiple regression model there was an association between the alteration in Hcy level over 0-12 months and MTX treatment, as well as the alteration in CRP, adjusted for B-vitamin treatment. Conclusions: In patients with RA, Hcy levels can be reduced by treatment with B-vitamins. The Hcy levels were related to markers of inflammation and MTX treatment.