vitamin-b-12 and Arthritis--Rheumatoid

Topics: Adalimumab; Aged; Antibodies, Monoclonal, Humanized; Arthritis, Rheumatoid; Cervical Vertebrae; Comorbidity; Female; Humans; Magnetic Resonance Imaging; Spinal Cord Diseases; Treatment Outcome; Tumor Necrosis Factor-alpha; Vitamin B 12; Vitamin B 12 Deficiency

A case of rheumateid arthritis (RA) with pernicious anemia (PA) and wandering multiple patchy densities in bilateral lung fields is reported. A 72-year-old woman was hospitalized in February 1994, because of cough. She had already advanced RA (Class IV, Stage IV). She showed macrocytic and hyperchromic anemia as follows ; red-cell count (RBC), 176 x 10(4)/microliters; hemoglobin (Hb),7.2 g/dl; hematocrit (Ht), 21.0% ; MCV, 119.3 fl; and MCH, 40.9 pg. Chest roentgenogram revealed multiple patchy densities in bilateral lung fields and there was no response to the administration of antibiotic agents. From these clinical pictures bronchiolitis obliterans organizing pneumonia (BOOP) was highly suspected. After steroid injection into the joint space, the abnormal lung shadows disappeared. Anemia had been recovering spontaneously, but recurred in July. The results of blood examination were as follows ; RBC, 162 x 10(4)/microliters; Hb, 6.7ng/dl; Ht, 19.1%; MCV, 117.9 fl; and MCH, 41.4 pg. Anti-intrinsic factor antibody was positive. The level of serum vitamin B12 was low, 76 pg/ml. Sternal bone marrow aspiration showed magaloblastic changes with hypersegmentation of granulocytes. PA was diagnosed and improvement was noted after the intramuscular administration of vitamin B12. Subjective symptoms based on RA did not change during the clinical course. It is suggested that the pathogenesis about the combination of RA, BOOP and PA is related to common immunological abnormalities in our patient. A case of RA with PA and BOOP has not been reported previously, thus this case is considered clinically valuable.

Topics: Aged; Anemia, Pernicious; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Cryptogenic Organizing Pneumonia; Female; Humans; Injections, Intramuscular; Methylprednisolone; Vitamin B 12

Topics: Anemia, Hemolytic; Anemia, Hypochromic; Anemia, Megaloblastic; Arthritis, Juvenile; Arthritis, Rheumatoid; Blood Volume; Collagen Diseases; Dermatomyositis; Felty Syndrome; Folic Acid; Hemolysis; Humans; Hyperplasia; Iron; Lupus Erythematosus, Systemic; Myositis; Polyarteritis Nodosa; Polymyalgia Rheumatica; Scleroderma, Systemic; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sideroblastic; Arthritis, Rheumatoid; Bone Marrow; Cobalt; Erythrocytes; Female; Folic Acid; Folic Acid Deficiency; Gastric Acidity Determination; Hemoglobinometry; Humans; Intestinal Absorption; Iron; Liver Extracts; Male; Mononuclear Phagocyte System; Plasma Volume; Potassium; Salicylates; Sex Factors; Steroids; Vitamin B 12

To investigate whether baseline concentrations of one-carbon metabolism biomarkers are associated with treatment nonresponse and adverse events in rheumatoid arthritis (RA) patients receiving methotrexate (MTX).. A prospective derivation cohort (n = 285) and validation cohort (n = 102) of RA patients receiving MTX were studied. Concentrations of plasma homocysteine, serum vitamin B12 , serum folate, erythrocyte vitamin B6 , and erythrocyte folate were determined at baseline and after 3 months of treatment. Nonresponse after 3 months was assessed using the Disease Activity Score in 28 joints (DAS28) and the European League Against Rheumatism (EULAR) response criteria. Adverse events at 3 months were assessed using biochemical parameters and health status questionnaires. Analyses were corrected for baseline DAS28, age, sex, MTX dose, comedications, and presence of the methylenetetrahydrofolate reductase 677TT genotype.. In the derivation cohort, the mean DAS28 scores at baseline and 3 months were 4.94 and 3.12, respectively, and 78% of patients experienced adverse events. This was similar between the 2 cohorts, despite a lower MTX dose in the validation cohort. Patients with lower levels of erythrocyte folate at baseline had a higher DAS28 at 3 months in both the derivation cohort (β = -0.15, P = 0.037) and the validation cohort (β = -0.20, P = 0.048). In line with these results, lower baseline erythrocyte folate levels were linearly associated with a 3-month DAS28 of >3.2 in both cohorts (derivation cohort, P = 0.049; validation cohort, P = 0.021) and with nonresponse according to the EULAR criteria (derivation cohort, P = 0.066; validation cohort, P = 0.027). None of the other biomarkers (levels at baseline or changes over 3 months) were associated with the DAS28 or treatment nonresponse. Baseline levels of the biomarkers and changes in levels after 3 months were not associated with incidence of adverse events.. A low baseline concentration of erythrocyte folate is associated with high disease activity and nonresponse at 3 months after the start of MTX treatment and could be used in prediction models for MTX outcome. None of the investigated one-carbon metabolism biomarkers were associated with incidence of adverse events at 3 months.

Topics: Adult; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Biomarkers; Drug Monitoring; Erythrocytes; Female; Folic Acid; Genotype; Homocysteine; Humans; Male; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Predictive Value of Tests; Prospective Studies; Vitamin B 12; Vitamin B 6

To determine if folinic acid supplementation during methotrexate (MTX) therapy for rheumatoid arthritis (RA) reduces both urinary 5-aminoimidazole-4-carboxamide (AICA) and urinary adenosine excretion more than does folic acid supplementation. AICA and adenosine are markers for MTX interference with purine metabolism.. Forty patients with RA who received MTX for 6 weeks were randomized to receive either daily folic acid or folinic acid supplements during an additional week of MTX therapy. Colorimetric and radioimmunocompetition assays were used to measure 24-hour urinary AICA and adenosine excretion levels, respectively.. At the end of 6 weeks, 24-hour urinary levels of AICA, but not adenosine, were elevated as compared with baseline levels (i.e., prior to MTX therapy). Folinic acid, but not folic acid, supplementation normalized urinary AICA levels during MTX therapy. Relatively high urinary levels of AICA were correlated with reduced disease activity. No similar correlations were seen with urinary adenosine levels.. The blockade of purine nucleotide biosynthesis by MTX at the AICA ribonucleotide transformylase-catalyzed step may be related to the efficacy of MTX, and this blockade is effectively relieved by folinic acid, but not by folic acid, supplementation.

Topics: Adenosine; Aminoimidazole Carboxamide; Arthritis, Rheumatoid; Erythrocytes; Female; Folic Acid; Homocysteine; Humans; Leucovorin; Male; Methotrexate; Middle Aged; Purines; Pyridoxine; Ribonucleotides; Treatment Outcome; Vitamin B 12

To study the influence of sulphasalazine (SSZ), methotrexate (MTX), and the combination (COMBI) of both on plasma homocysteine and to study the relation between plasma homocysteine and their clinical effects.. 105 patients with early rheumatoid arthritis (RA) were randomised between SSZ (2-3 g/day), MTX (7.5-15 mg/week), and the COMBI (same dose range) and evaluated double blindly during 52 weeks. Plasma homocysteine, serum folate concentrations, and vitamin B12 were measured. The influence of the C677T mutation of the enzyme methyl-enetetrahydrofolatereductase (MTHFR) gene was analysed.. A slight trend towards increased efficacy and an increased occurrence of minor gastrointestinal toxicity was present in the COMBI group, no differences existed clinically between SSZ and MTX. Only a slight and temporary increase in plasma homocysteine was found in the SSZ group, in contrast with the persistent rise in the MTX group and the even greater increase in the COMBI patients. Patients homozygous for the mutation in the MTHFR gene had significantly higher baseline homocysteine, heterozygous MTHFR genotype induced a significantly higher plasma homoeysteine at week 52 compared with no mutation. No correlation was found between clinical efficacy variables and homocysteine. Patients with gastrointestinal toxicity had a significantly greater increase in homocysteine.. A persistent increase in plasma homocysteine concentrations was observed in patients treated with MTX alone and more pronounced in combination with SSZ, in contrast with SSZ alone. An increase in plasma homocysteine is related to the C677T mutation in MTHFR. A relation in the change in homocysteine concentrations with (gastrointestinal) toxicity was found, no relation with clinical efficacy existed.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Digestive System; Double-Blind Method; Drug Therapy, Combination; Female; Folic Acid; Homocysteine; Humans; Male; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Mutation; Oxidoreductases Acting on CH-NH Group Donors; Sulfasalazine; Vitamin B 12

We tested the effects of an uncooked vegan diet, rich in lactobacilli, in rheumatoid patients randomized into diet and control groups. The intervention group experienced subjective relief of rheumatic symptoms during intervention. A return to an omnivorous diet aggravated symptoms. Half of the patients experienced adverse effects (nausea, diarrhoea) during the diet and stopped the experiment prematurely. Indicators of rheumatic disease activity did not differ statistically between groups. The positive subjective effect experienced by the patients was not discernible in the more objective measures of disease activity (Health Assessment Questionnaire, duration of morning stiffness, pain at rest and pain on movement). However, a composite index showed a higher number of patients with 3-5 improved disease activity measures in the intervention group. Stepwise regression analysis associated a decrease in the disease activity (measured as change in the Disease Activity Score, DAS) with lactobacilli-rich and chlorophyll-rich drinks, increase in fibre intake, and no need for gold, methotrexate or steroid medication (R2=0.48, P=0.02). The results showed that an uncooked vegan diet, rich in lactobacilli, decreased subjective symptoms of rheumatoid arthritis. Large amounts of living lactobacilli consumed daily may also have positive effects on objective measures of rheumatoid arthritis.

Topics: Adult; Alanine Transaminase; Alkaline Phosphatase; Arthritis, Rheumatoid; Blood Sedimentation; C-Reactive Protein; Chronic Disease; Cooking; Diet, Vegetarian; Female; Health Status Indicators; Hemoglobins; Humans; Lactobacillus; Male; Middle Aged; Patient Satisfaction; Platelet Count; Sodium; Vitamin B 12

To determine the effect of two different weekly doses of folic acid on the toxicity and efficacy of low-dose methotrexate therapy for rheumatoid arthritis.. Randomized, double-blind, placebo-controlled study.. 79 persons between 19 and 78 years of age who fulfilled the American Rheumatism Association's criteria for rheumatoid arthritis.. Participants were randomly assigned to visually identical placebo or to 5 mg or 27.5 mg of folic acid each week.. Duration, intensity, and clinical severity of toxic events; efficacy (indices of joint tenderness and swelling and grip strength); plasma and erythrocyte folate levels; and other laboratory variables.. Folic acid supplementation at either dose did not affect the efficacy of methotrexate therapy as judged by joint indices and patient and physician assessments of disease. Patients given folic acid supplements had lower toxicity scores than did participants given placebo (P < or = 0.001). Low blood folate levels and increased mean corpuscular volumes were associated with substantial methotrexate toxicity, whereas daily dietary intakes of more than 900 nmol (400 micrograms) of folic acid were associated with little methotrexate toxicity.. Folic acid, an inexpensive vitamin, is safe in a broad range of doses and protects patients with rheumatoid arthritis who are taking methotrexate from toxicity while preserving the efficacy of methotrexate.

Topics: Adult; Aged; Arthritis, Rheumatoid; Diet; Double-Blind Method; Drug Therapy, Combination; Erythrocytes; Female; Folic Acid; Humans; Male; Methotrexate; Middle Aged; Patient Dropouts; Treatment Outcome; Vitamin B 12

Topics: Arthritis, Rheumatoid; Clinical Trials as Topic; Humans; Neuritis; Osteoarthritis; Physical Therapy Modalities; Placebos; Spinal Diseases; Thiamine; Vitamin B 12

The aim of this study was to evaluate the variation of homocysteine (Hcy) levels in patients with rheumatoid arthritis (RA) and to analyze the relationship to inflammatory parameters, cardiovascular risk, and methotrexate (MTX).. This cross-sectional study assessed disease activity and treatment in RA patients. The European League Against Rheumatism (EULAR) 2015 HeartSCORE was performed for cardiovascular (CV) risk estimation and levels of plasma Hcy, serum folate concentrations, vitamin B12, and erythrocyte sedimentation rate (ESR) were measured.. A total of 103 participants with mean age 53 ± 10 years and mean disease duration 10.55 ± 7.34 years were included. Patients were treated with MTX in 69.9% of cases and corticosteroid in 80.5% of cases. Of all patients, 13% had a cardiovascular inheritance, 25% were hypertensive, and 18% had diabetes. The EULAR 2015 HeartSCORE was high and very high (≥5%) in 35% of cases. Mean Hcy level was 12.54 ± 4.2 µmol/L [6.89-32.92] and hyperhomocysteinemia was noted in 20.4% of patients. Analytic study demonstrated that hyperhomocysteinemia was associated with male gender (p = 0.01), MTX use (p = 0.01), smoking (p = 0.008), renal failure (p = 0.04), and high disease activity (p = 0.05), but there was no association with the HeartSCORE (p = 0.23). Hcy level was negatively correlated with folate (p = 0.009) and vitamin B12 level (p = 0.02) and positively with age (p = 0.01), C‑reactive protein (CRP; p = 0.05), and Simplified Disease Activity Index (SDAI; p = 0.03). In multivariate logistic regression analysis, current MTX use, levels of vitamin B12 and creatine, and Clinical Disease Activity Index (CDAI) appeared to be independent factors associated with hyperhomocysteinemia.. MTX use, CDAI, and the levels of vitamin B12 and creatine are independent factors associated with hyperhomocysteinemia.. HINTERGRUND: Ziel der vorliegenden Studie war es, Unterschiede in den Werten für Homocystein (Hcy) bei Patienten mit rheumatoider Arthritis (RA) und den Zusammenhang mit Entzündungsparametern, Herz-Kreislauf-Risiko und Methotrexat (MTX) zu untersuchen.. In dieser Querschnittstudie wurden Krankheitsaktivität und Therapie von RA-Patienten analysiert. Zur Abschätzung des kardiovaskulären Risikos wurde The European League Against Rheumatism (EULAR) 2015 HeartSCORE eingesetzt und die Werte für Plasma-Hcy, Folsäurekonzentration im Serum, Vitamin B12 und Blutsenkungsgeschwindigkeit (BSG) bestimmt.. Es wurden 103 Teilnehmer mit einem mittleren Alter von 53 ± 10 Jahren und einer mittleren Krankheitsdauer von 10,55 ± 7,34 Jahren in die Studie einbezogen. In 69,9% der Fälle wurden die Patienten mit MTX und in 80,5% mit Kortikosteroiden behandelt. Bei 13% der Patienten bestanden familiär kardiovaskuläre Erkrankungen, bei 25% Hypertonie und bei 18% Diabetes mellitus. In 35% der Fälle war der EULAR 2015 HeartSCORE hoch oder sehr hoch (>5%). Im Mittel betrug der Hcy-Wert 12,54 ± 4,2 µmol/l [6,89–32,92], und eine Hyperhomocysteinämie lag bei 20,4% der Patienten vor. Die Auswertung ergab, dass eine Hyperhomocysteinämie mit männlichem Geschlecht (p = 0,01), MTX-Therapie (p = 0,01), Rauchen (p = 0,008), Niereninsuffizienz (p = 0,04) und hoher Krankheitsaktivität (p = 0,05) assoziiert war, aber es gab keinen Zusammenhang mit dem HeartSCORE (p = 0,23). Der Hcy-Wert war negativ mit den Werten für Folsäure (p = 0,009) und Vitamin B12 (p = 0,02) korreliert und positiv mit dem Alter (p = 0,01), C‑reaktivem Protein (CRP; p = 0,05) und dem Simplified Disease Activity Index (SDAI; p = 0,03). In der multivariaten logistischen Regressionsanalyse schienen eine derzeitige MTX-Therapie, Werte für Vitamin B12 und Kreatin sowie der Clinical Disease Activity Index (CDAI) unabhängige Faktoren zu sein, die mit Hyperhomocysteinämie assoziiert waren.. MTX-Therapie, CDAI und die Werte für Vitamin B12 und Kreatin sind unabhängige, mit Hyperhomocysteinämie assoziierte Faktoren.

Topics: Adult; Arthritis, Rheumatoid; Cardiovascular Diseases; Creatine; Cross-Sectional Studies; Folic Acid; Heart Disease Risk Factors; Homocysteine; Humans; Inflammation; Male; Methotrexate; Middle Aged; Risk Factors; Vitamin B 12

The study investigated the association between plasma homocysteine, folate and vitamin B12 with 5,10 methylenetetrahydrofolate reductase (MTHFR C677T and A1298C), thymidylate synthase (TYMS 2R → 3R) and methionine synthase (MTR A2756G) polymorphisms and methotrexate (MTX) treatment and toxicity in Tunisian Rheumatoid arthritis (RA) patients.. A total of 185 patients with RA were included. Homocysteine (Hcy) was assessed by fluorescence polarization immunoassay, and folate and vitamin B12 were measured by chemiluminescence immunoassays. The genetic polymorphisms were analyzed by PCR or PCR-RFLP. Hyperhomocysteinemia (HHC) was considered for Hcy > 15 µmol/L.. MTHFR C677T polymorphism was associated with HHC in RA patients (multi-adjusted OR, 95% CI 2.18, [1.07-4.57]; p = 0.031). No association was detected with the remaining polymorphisms. Plasma Hcy, folate, and vitamin B12 did not differ according to each polymorphism, or with MTX treatment or toxicity. However, HHC was more prevalent in patients with than those without MTX toxicity (32.7 vs. 16.7%; p = 0.035).. The MTHFR 677TT genotype is an independent risk factor for HHC in Tunisians RA patients. HHC could be a useful marker of MTX toxicity in RA patients.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adult; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Female; Folic Acid; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Male; Methotrexate; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Thymidylate Synthase; Tunisia; Vitamin B 12

Hansen disease is an infectious chronic disease with various clinical manifestations. Its joint performance may easily mimic rheumatoid arthritis.. We report a case of a 57-year-old woman diagnosed with Hansen disease 10 years ago, who suffered from joints swelling, pain and joints deformities of both hands for 19 years. The skin on the hands showed rashes, thickening, desquamation and chapping, with both thenar muscles atrophy. She also had severe hypoalgesia of the whole body, and morning stiffness for one hour.. The final diagnosis was joint damage and peripheral neuropathy due to Hansen disease.. The patient received neurotrophic treatment instead of anti-rheumatic treatment.. At 1-year follow up, no further aggravation of joint swelling and pain was detected.. The correct diagnosis of Hansen disease involving joints depends on the combination of medical history, careful physical examination, and laboratory examination.

Topics: Arthritis, Rheumatoid; Diagnosis, Differential; Female; Humans; Joints; Leprosy; Middle Aged; Pain; Peripheral Nervous System Diseases; Skin; Thiamine; Vitamin B 12

Patients with persistent high levels of serum vitamin B12 were often referred to Hematology departments. In this study, characteristic of patients with serum vitamin B12 levels higher than 2500 pmol/L (high B12) were studied.. Prevalence of high B12 was evaluated during a 10-month period. Samples with high B12 were incubated with polyethylene glycol (PEG) and a new measurement of vitamin B12 was carried out using the supernatant. As a pilot study, 26 frozen samples with high B12 were evaluated for changes in vitamin B12 after PEG. Moreover, a prospective study was carried out during three consecutive months. Size exclusion chromatography was employed to demonstrate the presence of immune complexes (ICs) with plasma vitamin B12-binding proteins in some serum samples with high B12.. Prevalence of high B12 was 1.3%. Results from 26 frozen samples and from a prospective study (28 cases) showed that undergoing vitamin B12 treatment was the main cause of high B12. However, ICs were detected in 10 frozen samples and in seven cases (25%) of the prospective study, respectively. Serum vitamin B12 decreased to normal values after precipitation with PEG, and size exclusion chromatography confirmed ICs. An association with autoimmune or hematological disorders was observed.. In patients with repeatedly high B12 levels, ICs were detected in approximately 25% of samples. Precipitation with PEG is an easy method to confirm the presence of ICs and to evaluate serum vitamin B12 levels in these patients.

Topics: Aged; Aged, 80 and over; Anemia, Iron-Deficiency; Antigen-Antibody Complex; Arthritis, Rheumatoid; Autoantibodies; Female; Freezing; Hematologic Neoplasms; Humans; Male; Middle Aged; Pilot Projects; Polyethylene Glycols; Prevalence; Prospective Studies; Spain; Vitamin B 12

Chronic inflammation in rheumatoid arthritis is associated with vascular endothelial dysfunction. The objective was to study the efficacy and safety of advanced glycation end products (AGEs) inhibitor (benfotiamine 50 mg + pyridoxamine 50 mg + methylcobalamin 500 μg, Vonder(®) (ACME Lifescience, Baddi, Himachal Pradesh, India)) on endothelial function in rheumatoid arthritis (RA).. Twenty-four patients with established active RA with high disease activity (Disease Activity Score of 28 joints [DAS28 score] > 5.1) despite treatment with stable doses of conventional disease-modifying antirheumatic drugs were investigated. Inflammatory disease activity (DAS28 and Health Assessment Questionnaire-Disability Index [HAQ-DI] scores, erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP]), markers of endothelial dysfunction, serum nitrite concentration and endothelium-dependent and -independent vasodilation of the brachial artery were measured before and after 12 weeks therapy with twice a day oral AGEs inhibitor.. After treatment, flow-mediated vasodilation improved from 9.64 ± 0.65% to 15.82 ± 1.02% (P < 0.01), whereas there was no significant change in endothelium-independent vasodilation with nitroglycerin and baseline diameter; serum nitrite concentration significantly reduced from 5.6 ± 0.13 to 5.1 ± 0.14 μmol/L (P = 0.004), ESR from 63.00 ± 3.5 to 28.08 ± 1.5 mm in the first h (P < 0.01) and CRP levels from 16.7 ± 4.1 to 10.74 ± 2.9 mg/dL (P < 0.01). DAS28 and HAQ-DI scores were significantly reduced, from 5.9 ± 0.17 to 3.9 ± 0.17 (P < 0.01) and 4.6 ± 0.17 to 1.7 ± 0.22 (P < 0.01), respectively.. Advanced glycation end products inhibitor improves endothelial dysfunction and inflammatory disease activity in RA. In RA, endothelial dysfunction is part of the disease process and is mediated by AGEs-induced inflammation.

Topics: Administration, Oral; Adult; Aged; Anti-Inflammatory Agents; Arthritis, Rheumatoid; Biomarkers; Blood Sedimentation; Brachial Artery; C-Reactive Protein; Disability Evaluation; Endothelium, Vascular; Female; Glycation End Products, Advanced; Humans; India; Linear Models; Male; Middle Aged; Multivariate Analysis; Pyridoxamine; Severity of Illness Index; Surveys and Questionnaires; Thiamine; Time Factors; Treatment Outcome; Vasodilation; Vitamin B 12; Vitamin B Complex; Young Adult

The purpose of this study was to determine if nonsupplementing older women (aged >or=55 years) with rheumatoid arthritis had higher plasma homocysteine and lower B-vitamin status compared to healthy controls. Elevated plasma homocysteine, a risk factor for cardiovascular disease, may help explain why individuals with rheumatoid arthritis have an increased risk of cardiovascular disease.. Older, free-living women were classified as rheumatoid arthritis (n=18) or healthy control (n=33). Participants were not using B-vitamin supplements. Fasting blood samples were measured for pyridoxal 5'phosphate (PLP) (the metabolically active coenzyme form of vitamin B-6), folate, red blood cell folate, vitamin B-12, transcobalamin II, homocysteine, C-reactive protein, and lipid concentrations. Participants completed 7-day weighed food records, the Stanford Health Assessment Questionnaire (HAQ), and a visual analog pain scale.. PLP concentrations were lower in the rheumatoid arthritis vs healthy control participants (4.93+/-3.85 vs 11.35+/-7.11 ng/mL [20+/-16 vs 46+/-29 nmol/L]; P<0.01) whereas plasma homocysteine was higher in the rheumatoid arthritis group (1.63+/-0.74 vs 1.15+/-0.38 mg/L [12.1+/-5.5 vs 8.5+/-2.8 micromol/L]; P=0.02). Red blood cell folate concentrations were lower in the rheumatoid arthritis vs healthy control participants [414+/-141 vs 525+/-172 ng/mL [938+/-320 vs 1,190+/-390 nmol/L]; P=0.02). No significant differences were found for plasma folate, vitamin B-12, and transcobalamin II. An inverse correlation was found between PLP concentrations and the HAQ disability index (r=-0.37; P<0.01). A positive correlation was found between homocysteine concentrations and the HAQ disability index (r=0.36; P=0.01). Total cholesterol and low-density lipoprotein cholesterol levels were lower in the rheumatoid arthritis group (cholesterol 191+/-43 vs 218+/-33 mg/dL [4.95+/-1.11 vs 5.65+/-0.85 mmol/L]; P=0.02; low-density lipoprotein cholesterol 110+/-36 vs 137+/-29 mg/dL [2.85+/-0.93 vs 3.55+/-0.75 mmol/L]; P<0.01). No significant differences were seen between groups for protein (g/day), fat (g/day), cholesterol (mg/day), folate (microg/day), vitamin B-12 (microg/day), and vitamin B-6 (mg/day) dietary intakes.. Poor vitamin B-6 status and elevated plasma homocysteine concentrations were seen in older women with rheumatoid arthritis compared to healthy controls and may contribute to their increased risk of cardiovascular disease.

Topics: Aged; Arthritis, Rheumatoid; C-Reactive Protein; Cardiovascular Diseases; Case-Control Studies; Cross-Sectional Studies; Diet Records; Erythrocytes; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Lipids; Middle Aged; Nutritional Status; Pyridoxal Phosphate; Risk Factors; Transcobalamins; Vitamin B 12; Vitamin B 6; Vitamin B 6 Deficiency; Vitamin B Complex

To investigate the distribution of the A2756G polymorphism of the methionine synthase reductase (MTR) gene in patients with rheumatoid arthritis (RA) treated with methotrexate (MTX) compared with a healthy control group; and to examine the relationships among the A2756G polymorphism, plasma total homocysteine (tHcy), serum folate and vitamin B12 levels, disease activity, and MTX toxicity in patients with RA.. A cross-sectional study was performed on 86 MTX-treated RA patients, consisting of a clinical interview and physical examination to determine disease activity and MTX-related adverse reactions. Genotype analysis of the MTR gene was performed. Fasting plasma tHcy, serum folate, and vitamin B12 levels were measured. Allele and genotype distributions were compared to a healthy control group.. The frequency of the 2756GG genotype (16.3%) in the RA study group was higher than that expected in the general population (3.6%; p < 0.000001). This genotype was associated with MTX-induced accelerated rheumatoid nodulosis (MIARN). No association of disease activity variables or plasma homocysteine with MTR A2756G polymorphisms was observed. The MTR 2756GG genotype, low plasma vitamin B12 levels, and the presence of rheumatoid nodules predicted MIARN. No association of nodulosis with any other indicator of disease activity or medical treatment was found.. In our population of MTX-treated RA patients the 2756GG genotype of the MTR gene was more common than expected and was associated with MIARN.

Topics: Adult; Aged; Antirheumatic Agents; Arthritis, Rheumatoid; Case-Control Studies; Cross-Sectional Studies; Female; Ferredoxin-NADP Reductase; Genotype; Homocysteine; Humans; Male; Methotrexate; Middle Aged; Polymorphism, Single Nucleotide; Pteroylpolyglutamic Acids; Rheumatic Nodule; Severity of Illness Index; Vitamin B 12

The purpose of this study was to investigate whether negative effects of methotrexate (mtx) on blood homocysteine (hmc) levels can be prevented with the replacement of folic acid. 42 female patients with rheumatoid arthritis (RA) were studied. Patients were separated into two groups according to their treatment status with mtx (group I: 27 patients taking mtx and folic acid; group II: 15 patients not using mtx). The level of hmc was found to be 6.3+/-2.4 micromol/l in group I and 7.87+/-3.2 micromol/l in group II (p>0.05). Folic acid levels of group I and II were found to be 21.3+/-15.9 ng/ml and 8.41+/-2.86 ng/ml respectively (p<0.001). There was a statistically-significant correlation between age and hmc levels (r=0.386, p=0.012). Negative statistically-significant correlations were observed between folic acid and hmc levels. The effects of mtx on hmc can be prevented with the replacement of folic acid.

Topics: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Immunosuppressive Agents; Methotrexate; Middle Aged; Statistics, Nonparametric; Vitamin B 12; Vitamin B Complex

Although anemia is frequent in inflammatory rheumatic diseases, data regarding vitamin B12 status is scarce. The purpose of this study was to analyze the incidence and nature of B12 and folic acid (FA) deficiencies in a cohort of rheumatic patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and systemic lupus erythematosus (SLE).. Levels of B12, FA, and parameters of anemia were recovered or examined in 276 outpatients. In those with recent findings of low serum B12 levels, further studies of serum homocysteine (Hcy) and urine methylmalonic acid (MMA) levels were performed.. The incidence of anemia was high: 49%, 46%, and 35%, in RA, SLE, and PsA, respectively. Low levels of serum B12 were also frequent (24%), with almost similar occurrence in the three disease groups. Deficiency in FA was rare (<5%). Mean levels of both vitamins did not differ significantly among the three groups. No correlation between serum B12 levels and anemia was found. In the 15 patients with recently detected low B12 levels, Hcy and MMA were evaluated before and following B12 therapy. In ten of them, baseline Hcy levels were high, while MMA was increased in one patient only. Response to B12 administration, i.e., a decrease in Hcy and/or MMA levels, was noticed in four patients only, suggesting that only 26% of the low-serum-B12 patients had true B12 deficiency.. The incidences of anemia and decreased serum B12 levels were high in these three groups of rheumatic patients. However, true tissue deficiency seems to be much rarer.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Arthritis, Psoriatic; Arthritis, Rheumatoid; Cohort Studies; Female; Folic Acid Deficiency; Homocysteine; Humans; Incidence; Israel; Lupus Erythematosus, Systemic; Male; Methylmalonic Acid; Middle Aged; Retrospective Studies; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

The risk of cardiovascular disease (CVD) is increased in patients with rheumatoid arthritis (RA). The objective of this study was to examine the distribution of known CVD risk factors and biomarkers of CVD in women with and without RA.. This study included two components: an examination of clinical CVD risk factors among women participating in the Nurses' Health Study, a prospective longitudinal cohort, and an analysis of CVD biomarkers among a subgroup of women from this cohort who provided a blood specimen in 1989 (biospecimen cohort). Data regarding clinical risk factors for CVD were collected in 1990 by mailed questionnaire. The diagnosis of RA was confirmed through a structured medical record abstraction. We compared clinical risk factors for CVD and biomarkers of CVD between women with and without RA, adjusting for age, body mass index (BMI), smoking status, and menopause status.. Women with RA (n = 287) were significantly more likely than women without RA (n = 87,019) to report no alcohol use (48.2% versus 39.4%) and past cigarette smoking (47.8% versus 38.0%). No significant differences between these groups were observed for current smoker status, BMI, regular aspirin use, diabetes, hypertension, physical activity, and family history of early myocardial infarction. In the biospecimen cohort (69 RA cases and 491 controls), the levels of several inflammatory biomarkers linked to CVD were significantly elevated in women with RA, including CRP, fibrinogen, sICAM-1, sTNFRI, sTNFRII, and osteoprotegerin. Levels of total cholesterol, low-density lipoprotein, triglycerides, apolipoprotein B, and Lp(a) were similar between groups. Levels of homocysteine were similar, but vitamin B(12) was significantly higher among women with RA than among the controls.. In women participating in the Nurses' Health Study, most traditional CVD risk factors were similar between those who had RA and those who did not. However, as expected, biomarkers of inflammation associated with CVD were generally elevated in women with RA.

Topics: Adult; Arthritis, Rheumatoid; Biomarkers; Cardiovascular Diseases; Case-Control Studies; Cohort Studies; Female; Humans; Longitudinal Studies; Middle Aged; Nurses; Prospective Studies; Risk Factors; Surveys and Questionnaires; Vitamin B 12; Women's Health

To investigate the effect of methotrexate (MTX) treatment of rheumatoid arthritis (RA) on folate metabolism, and to determine the effect of low dose folic acid on toxicity, efficacy, and folate status.. A 52-week prospective study of 81 patients with RA treated with MTX and self-administered low dose folic acid; 38 patients were included prior to MTX therapy, 33 patients continued established MTX therapy, and 10 patients were excluded. Drug efficacy and side effects were monitored with biochemical and clinical indicators.. MTX treatment resulted in decreased concentrations of red blood cell (RBC) folate and a rise in plasma homocysteine. Intracellular concentrations of MTX were inversely correlated to RBC folate levels after treatment for a longer period (mean 41 months). Supplement with low dose folic acid prevented or diminished the influence of MTX on folate status and had a protective effect on MTX induced liver toxicity without changing the efficacy of MTX.. MTX interferes with folate and homocysteine metabolism, and the intracellular concentration of MTX may play a role. Our results indicate low dose folic acid supplementation has a beneficial effect on MTX toxicity.

Topics: Arthritis, Rheumatoid; Biomarkers; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Male; Methotrexate; Probability; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Single-Blind Method; Treatment Outcome; Vitamin B 12

Moderate hyperhomocysteinaemia related to folate deficiency has been described in patients with cardiovascular risk and also in patients with autoimmune diseases including rheumatoid arthritis (RA).. In 33 patients with RA, serum concentrations of homocysteine and cysteine, of B-vitamins folate and vitamin B(12), and of immune activation markers neopterin and soluble 75-kDa TNF-receptor (sTNF-R75) were measured.. A significant proportion of patients presented with elevated homocysteine and cysteine concentrations in comparison to reference ranges of healthy control persons. Moderate hyperhomocysteinaemia coincided with decreased serum folate and with higher concentrations of sTNF-R75 and neopterin, but it was rather independent from methotrexate (MTX) therapy.. The coincidence of higher homocysteine and lower folate concentrations with increased concentrations of immune activation markers in patients with RA suggests that immune activation could be involved in the development of hyperhomocysteinaemia.

Topics: Adult; Aged; Antigens, CD; Arthritis, Rheumatoid; Cysteine; Female; Homocysteine; Humans; Hyperhomocysteinemia; Male; Middle Aged; Receptors, Tumor Necrosis Factor; Receptors, Tumor Necrosis Factor, Type II; Vitamin B 12

Since moderate hyperhomocysteinemia is an independent risk factor for vascular disease and physiological thiol compounds mediate Cu2+- and Fe3+-dependent low-density lipoprotein (LDL) oxidation, we have studied the total plasma concentrations of thiol compounds including methionine as precursor of homocysteine in rheumatoid arthritis patients, in which the high mortality found is associated with cardiovascular disease.. Thirty-eight women with rheumatoid arthritis and 25 age-matched control women were studied. Plasma was used to measure thiol compounds and amino acids by HPLC.. Rheumatoid arthritis patients showed significantly higher levels than healthy controls of total plasma homocysteine (17.3 +/- 7.8 vs. 7.6 +/- 1.9; p <0.001), cysteine (293 +/- 61 vs. 201 +/- 45; p < 0.001), cysteinglycine (32.7 +/- 8.3 vs. 22.3 +/- 4.7; p < 0.001) and methionine (25 +/- 9 vs. 18 +/- 3; p < 0.01), whereas total glutathione levels were not increased (4.7 +/- 2.0 vs. 4.1 +/- 1.6).. The increased levels of thiol compounds found in rheumatoid. arthritis patients may be implicated in the increased incidence of cardiovascular disease found in these patients by means of the toxic effect of homocysteine on endothelium and the increased susceptibility of LDL to oxidation by increased plasma amounts of thiol compounds such as cysteine.

Topics: Adult; Amino Acids; Arthritis, Rheumatoid; Cysteine; Female; Folic Acid; Glutathione; Glycine; Homocysteine; Humans; Middle Aged; Vitamin B 12

To analyze the significance of cobalaminopenia (< 200 pmol/l) in patients with severe rheumatoid arthritis (RA).. We studied 42 patients with RA and cobalaminopenia (incidence 4%). Most patients had severe and longstanding disease. Concentrations of homocysteine, methylmalonic acid (MMA), gastrin, and pepsinogen 1 were analyzed in sera that had been stored frozen. A capillary gas chromatographic mass spectrometric technique was used to determine homocysteine and MMA.. As a group, patients had significantly higher levels of serum homocysteine and serum MMA than laboratory reference probands (p < 0.0001 and p < 0.005, respectively). Individually, 20 of 39 patients had elevated serum levels of homocysteine (> 15 micromol/l). In 12 of 39 patients serum levels of MMA were elevated (> 0.37 micromol/l). Twenty of 42 patients had biochemical signs of disturbed gastric function.. Our findings were compatible with the hypothesis that cobalaminopenia is one of several biochemical signs of gastrointestinal dysfunction in patients with severe RA. It is suggested that the hyperhomocysteinemia associated with vitamin B12 deficiency, folate deficiency, vitamin B6 deficiency, and impaired renal function may have a role in promoting high cardiovascular morbidity in patients with RA.

Topics: Adult; Aged; Aged, 80 and over; Arthritis, Rheumatoid; Female; Homocysteine; Humans; Male; Methylmalonic Acid; Middle Aged; Pilot Projects; Retrospective Studies; Vitamin B 12

To assess total homocysteine (tHcy) metabolism in patients with rheumatoid arthritis (RA).. Assessments were performed to determine the fasting levels of tHcy and the increase in tHcy in response to methionine (Met) challenge in blood samples from 28 patients with RA and 20 healthy age-matched control subjects.. Fasting levels of tHcy were 33% higher in the RA patients than in the control subjects (mean +/- SD 11.7 +/- 1.5 nmoles/ml versus 8.8 +/- 1.1 nmoles/ml; P < 0.01). Four hours after Met challenge, the increase in plasma tHcy levels (delta tHcy) was higher in the RA patients (20.9 +/- 10.4 nmoles/ml) than in the control subjects (15.5 +/- 1.6 nmoles/ml) (P < 0.02). In a subgroup analysis, the delta tHcy in patients taking methotrexate (12.9 +/- 2.2 nmoles/ml) did not differ from that in the control group, while the delta tHcy in patients not taking methotrexate (25.3 +/- 1.7 nmoles/ml) was significantly higher (P < 0.0001).. Elevated tHcy levels occur commonly in patients with RA, and may explain some of the increased cardiovascular mortality seen in such patients. Studies of the prevalence and mechanism of hyperhomocysteinemia in RA are warranted.

Topics: Adult; Aged; Arthritis, Rheumatoid; Fasting; Female; Homocysteine; Humans; Male; Methionine; Methotrexate; Middle Aged; Vitamin B 12; Vitamin B 12 Deficiency

This study investigated whether methotrexate, by interrupting the methyl transfer function of folate, can induce genomic DNA hypomethylation in patients with inflammatory arthritis. Consecutive subjects with inflammatory arthritis (rheumatoid or psoriatic), who were taking methotrexate (n = 7) or other medications (n = 6), and control subjects, either healthy or with osteoarthritis and taking nonsteroidal anti-inflammatory agents only (n = 9) were recruited. The methylation status of genomic DNA from peripheral blood mononuclear cells was determined. Plasma levels of folate, B12, and pyridoxal-5'-phosphate (PLP), all of which are involved in biologic methylation, were also examined. The extent of genomic DNA methylation was lowest in subjects with inflammatory arthritis who were not taking methotrexate, highest in subjects with inflammatory arthritis who were taking methotrexate, and intermediate in control subjects (p < 0.05). Plasma levels of folate and B12 were similar among the three groups. The mean plasma PLP level in subjects with inflammatory arthritis was 33% lower than that in control subjects (p = 0.04). No significant correlation between genomic DNA methylation and folate, B12, and PLP levels was observed. These data do not support the hypothesis that methotrexate induces genomic DNA hypomethylation. However, these data indicate that inflammatory arthritis is associated with genomic DNA hypomethylation that is reversed with methotrexate. Future studies using a larger number of subjects are warranted to confirm these findings.

Topics: Adult; Antirheumatic Agents; Arthritis, Psoriatic; Arthritis, Rheumatoid; DNA Methylation; Female; Folic Acid; Homocysteine; Humans; Male; Methotrexate; Middle Aged; Vitamin B 12

To compare vitamin B6 levels in rheumatoid arthritis (RA) patients and healthy control subjects.. We measured levels of vitamin B6 in 23 adults with well-controlled RA, and in 23 healthy control subjects matched for age, sex, race, and weight.. Although plasma folate and vitamin B12 concentrations and erythrocyte B6 activity coefficients were similar in the patients and controls, plasma levels of pyridoxal-5'-phosphate (PLP) were lower in the RA patient group (mean +/- SD 46.1 +/- 48.1 versus 69.3 +/- 58.4 nmoles/liter; P < 0.004). In multivariate analyses, PLP was inversely associated with tumor necrosis factor alpha (TNF alpha) production by peripheral blood mononuclear cells (PBMC) (P < 0.001), after adjustment for age, pain score, erythrocyte sedimentation rate, and use of nonsteroidal antiinflammatory drugs.. PLP levels are reduced in patients with RA. This reduction is associated with TNF alpha production by PBMC.

Topics: Adult; Aged; Arthritis, Rheumatoid; Cachexia; Cross-Sectional Studies; Diet; Endotoxins; Female; Folic Acid; Humans; Male; Middle Aged; Pyridoxal Phosphate; Pyridoxine; Tumor Necrosis Factor-alpha; Vitamin B 12

Recently in Japan, one form of vitamin B12, methylcobalamin also known as methyl B12, has attracted the attention of physicians as a therapy for patients with rheumatoid arthritis. However, its immunological actions in vivo are still unknown. In this study, we induced the in vitro production of such cytokines as interleukin-6 (IL-6), interferon-gamma (IFN-gamma), and interleukin-1 beta (IL-1 beta) by adding various mitogens (phytohemagglutinin:PHA, concanavalin A: ConA, or pokeweed mitogen:PWM) as well as recombinant interleukin-2, and we investigated the effects of methyl B12 (final concentration, 8-8,000 ng/ml) on the production of these cytokines by peripheral mononuclear cells. As compared to the controls, IL-6 production induced by PHA and ConA on Day 4 of the culture was suppressed by an average 60-70% when methyl B12 (80-8,000 ng/ml) was added to the medium. IFN-gamma production decreased dose-dependently with methyl B12, i.e., it decreased to 46% of the control when this production was induced by rIL-2, and decreased to 56-66% when it was induced by mitogens. The effect of methyl B12 on IL-1 beta production on Day I of the culture was small. These findings indicate that methyl B12 suppresses mainly the cytokine production of T lymphocytes. Such suppressive effects as shown in the in vitro situation are expected to be expressed also in vivo in patients with rheumatoid arthritis, especially at articulation lesion sites.

Topics: Arthritis, Rheumatoid; Concanavalin A; Cytokines; Humans; In Vitro Techniques; Interferon-gamma; Interleukin-1; Interleukin-2; Interleukin-6; Leukocytes, Mononuclear; Phytohemagglutinins; Pokeweed Mitogens; T-Lymphocytes; Vitamin B 12

We have previously shown that when patients with active rheumatoid arthritis (RA) were examined for the ability of their lymphocytes to respond in the autologous mixed lymphocyte reaction (AMLR), profoundly reduced AMLR responses were found in the RA patients. The defects were mainly due to the impaired response of CD8+ and CD4+ Law8- subsets; however, both CD4+Leu8+ and CD4+ + Leu8- cells functioned normally as responding cells. The present study demonstrated that the abnormalities of RA CD8+ T cells in the AMLR were corrected when the AMLR cultures were set up in the presence of methyl-B12. In addition, a main target of the methyl-B12 effect observed was both CD8+Leu8+ and CD8+Leu8- cells. Thus, methyl-B12 may become a potential agent that would be able to control the pathophysiology of RA.

Topics: Adult; Arthritis, Rheumatoid; Female; Humans; Lymphocyte Activation; Lymphocyte Culture Test, Mixed; Male; T-Lymphocytes; Vitamin B 12

The distribution of endogenous cobalamin among serum cobalamin-binding proteins was studied in 30 patients with active rheumatoid arthritis (RA) and 27 in clinical remission. The mean total serum cobalamin concentration (holo-transcobalamin I and II) was similar in both groups of patients, whereas mean apotranscobalamin II was significantly increased in patients with active RA. The clinical significance of this finding is not yet established but it might be a useful parameter for the evaluation of disease activity in RA.

Topics: Adult; Aged; Arthritis, Rheumatoid; Female; Humans; Male; Middle Aged; Osmolar Concentration; Transcobalamins; Vitamin B 12

Two anemic patients with rheumatoid arthritis were treated with recombinant human erythropoietin (EPO) for 5 months. Both patients showed significant increases in hematocrit, red cell volumes, and marrow erythroid and megakaryocyte progenitor cells. No significant toxic effects from EPO were observed. These data indicate that EPO may be effective in overcoming the pathogenetic factors that limit erythropoiesis in rheumatoid arthritis.

Topics: Adult; Anemia; Arthritis, Rheumatoid; Blood Cell Count; Bone Marrow; Colony-Forming Units Assay; Erythropoietin; Female; Hematocrit; Humans; Middle Aged; Recombinant Proteins; Vitamin B 12

Seven clinical and laboratory indices of disease activity were compared with serum vitamin B12 levels in 32 patients with rheumatoid arthritis treated with penicillamine (16 patients) or sulphasalazine (16 patients) for up to 24 weeks. Prior to treatment each patient had active disease but a normal or low serum vitamin B12 concentration. During treatment, significant improvements occurred in all clinical and laboratory measurements but vitamin B12 levels were unchanged. We have been unable to confirm a reported positive association between rheumatoid disease activity and serum B12 concentration.

Topics: Adult; Aged; Arthritis, Rheumatoid; Female; Humans; Male; Middle Aged; Penicillamine; Sulfasalazine; Vitamin B 12

Studies were performed using an in vitro assay system to determine whether or not methyl-B12 could affect human T-cell function. When T cells were stimulated with phytohemagglutinin and allogeneic B cells, methyl-B12 did not enhance T-cell proliferation. In contrast, remarkable enhancing effects of methyl-B12 on the proliferative response to concanavalin A (Con A) and autologous B cells at suboptimal concentrations were observed, ranging from 0.1 to 10 micrograms/ml. Concentrations of methyl-B12 sufficient to enhance cellular proliferation were able to enhance the activity of helper T cells for immunoglobulin synthesis of B cells by pokeweed mitogen. Furthermore, the presence of methyl-B12 significantly potentiated the induction of suppressor cells in Con A-activated cultures. These results suggest that methyl-B12 could modulate lymphocyte function through augmenting regulatory T-cell activities.

Topics: Antibody-Producing Cells; Arthritis, Rheumatoid; B-Lymphocytes; Cell Differentiation; Concanavalin A; Humans; Immunity, Cellular; Immunoglobulin M; Lymphocyte Activation; Phytohemagglutinins; Pokeweed Mitogens; T-Lymphocytes; T-Lymphocytes, Regulatory; Vitamin B 12

In addition to the usual parameters for haematologic an rheumatologic diseases folic acid, vitamin B12, and ferritin were investigated by radioisotope studies. In some groups folic acid was lower compared to controls, and it is possible that the disease causes the deficiency of folic acid absorption and distribution. Vitamin B12 was only slightly decreased, thus, the values may be assumed to be close to normals. Transferrin ankylosing spondylitis is similar to that of controls, however, transferrin increases in rheumatoid arthritis and in mixed groups containing patients various diseases. Finally, the deficiency of folic acid absorption can be assumed to be caused by the symptoms of the disease, whereas in the case of inflammatory diseases and in mixed group transferrin increased.

Topics: Adult; Aged; Anemia, Hypochromic; Arthritis, Rheumatoid; Female; Ferritins; Folic Acid; Hematologic Tests; Humans; Male; Middle Aged; Radioisotopes; Spondylitis, Ankylosing; Vitamin B 12

The anaemia in rheumatoid arthritis is apparently of complex origin, in which case an increased accumulation of iron in the RES and the decreased utilisation of storage iron play the quantitatively most important role. According to literary data megaloblastic anaemias shall not appear frequently in rheumatoid arthritis. The frequency of the anaemia is rheumatoid arthritis is clearly depending on the composition of the collective of patients. In our patients anaemia and hypoferraemia do not correlate with the actual activity of the disease, however with the extension of the affection of the joints and the progressing of the basic disease. Anaemia and hypoferraemia may, therefore, be valuated as prognostically unfavourable signs. We could prove decreased vitamin B12-levels in 11.6%. There was no statistically significant relation to the course of the disease. An inhibition of the resportion of vitamin B12 by means of a long-term therapy is discussed.

Topics: Anemia; Arthritis, Rheumatoid; Hemoglobins; Humans; Iron; L-Lactate Dehydrogenase; Middle Aged; Vitamin B 12

To elucidate the role of vitamin B12 in the formation of anemia in patients with rheumatoid arthritis serum B12 levels were investigated in patients with rheumatoid arthritis, patients with osteoarthritis and normal subject. Serum B12 level in patients with rheumatoid arthritis was significantly higher than that in patients with osteoarthritis and normal subjects. Serum B12 level increased in proportion to Steinbrocker's stages, and was related more closely to hemoglobin concentration than to erythrocyte count and had a high correlation with alpha1- and alpha2-globulin.

Topics: Adult; Aged; Arthritis, Rheumatoid; Blood Sedimentation; Female; Humans; Male; Middle Aged; Osteoarthritis; Serum Globulins; Vitamin B 12

Topics: Adolescent; Adult; Arthritis, Rheumatoid; Female; Gout; Humans; Male; Middle Aged; Radioimmunoassay; Vitamin B 12

Topics: Adult; Aged; Arthritis, Rheumatoid; Chronic Disease; Female; Humans; Male; Middle Aged; Vitamin B 12

Topics: Arthritis; Arthritis, Rheumatoid; Humans; Immunoglobulin G; Milk, Human; Protein Binding; Rheumatoid Factor; Saliva; Tears; Vitamin B 12

Topics: Adult; Aged; Arthritis; Arthritis, Rheumatoid; Back Pain; Cervical Vertebrae; Drug Combinations; Drug Evaluation; Flufenamic Acid; Humans; Joint Diseases; Male; Middle Aged; Palliative Care; Periarthritis; Pyridoxal; Spinal Osteophytosis; Thiamine; Vitamin B 12

Topics: Acute Disease; Aminopyrine; Arthritis, Rheumatoid; Dexamethasone; Drug Combinations; Female; Humans; Lidocaine; Male; Pain; Phenylbutazone; Prednisolone; Riboflavin; Thiamine; Vitamin B 12

Topics: Anemia; Arthritis, Rheumatoid; Blood Proteins; Bone Marrow; Bone Marrow Cells; Chronic Disease; Erythropoietin; gamma-Globulins; Hematocrit; Humans; Infections; Iron; Neoplasms; Protein Biosynthesis; Serum Albumin; Transferrin; Vitamin B 12

Topics: Adult; Anemia, Macrocytic; Arthritis, Rheumatoid; Blood Transfusion; Folic Acid; Humans; Male; Thrombocytopenia; Vitamin B 12

Four consecutive patients with megaloblastic anaemia who also received therapy with trimethoprim-sulphamethoxazole all showed poor responses to specific haematinic therapy. This was attributed to trimethoprim, which suppressed reticulocyte responses in three cases and produced a pancytopenia in two and a falling haemoglobin with neutropenia in a third. A fourth patient, with pernicious anaemia, had a satisfactory reticulocyte response but experienced no clinical benefit until after withdrawal of trimethoprim.Trimethoprim seems not to be a safe form of therapy in patients with a megaloblastic process; many of the toxic reactions reported with this drug may be on the basis of an unrecognized megaloblastic form of haemopoiesis.

Topics: Adult; Aged; Agranulocytosis; Anemia, Macrocytic; Anemia, Pernicious; Anti-Infective Agents; Arthritis, Rheumatoid; Blood Platelets; Erythrocyte Count; Female; Folic Acid; Folic Acid Antagonists; Folic Acid Deficiency; Humans; Middle Aged; Pyrimidines; Reticulocytes; Sulfamethoxazole; Tetrahydrofolate Dehydrogenase; Trimethoprim; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Arthritis; Arthritis, Rheumatoid; Humans; Osteoarthritis; Synovial Fluid; Vitamin B 12

Topics: Adult; Anemia, Pernicious; Antibody Formation; Arthritis, Rheumatoid; Autoantibodies; Female; Fluorescent Antibody Technique; Folic Acid; Gastric Juice; Hemagglutination Tests; Hodgkin Disease; Humans; Immunodiffusion; Intrinsic Factor; Leukemia, Lymphoid; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Middle Aged; Multiple Myeloma; Pyrazoles; Radioimmunoassay; Vitamin B 12

Topics: Alanine Transaminase; Alkaline Phosphatase; Arthritis, Rheumatoid; Aspartate Aminotransferases; Celiac Disease; Cholesterol; Fats; Feces; Folic Acid; Humans; Kidney Diseases; Liver Function Tests; Malabsorption Syndromes; Nucleotidases; Rheumatic Diseases; Serum Albumin; Sulfobromophthalein; Vitamin B 12; Xylose

Topics: Aged; Anemia, Hypochromic; Anemia, Pernicious; Arthritis, Rheumatoid; Circadian Rhythm; Dementia; Female; Femoral Fractures; Folic Acid; Hemoglobins; Humans; Iron; Male; Urea; Vitamin B 12; Wales

Topics: Adult; Aged; Analgesics; Arthritis, Rheumatoid; Dexamethasone; Female; Humans; Male; Middle Aged; Pain; Phenylbutazone; Pyrazoles; Rheumatic Diseases; Rheumatic Fever; Time Factors; Vitamin B 12

Topics: Arthritis, Rheumatoid; Dexamethasone; Female; Hip Joint; Humans; Humerus; Injections, Intra-Articular; Knee Joint; Lidocaine; Middle Aged; Polymyalgia Rheumatica; Rheumatic Diseases; Thiamine; Vitamin B 12

Topics: Acetates; Adult; Aged; Arthritis, Rheumatoid; Female; Humans; Male; Middle Aged; Neuralgia; Periarthritis; Propylamines; Pyridoxine; Rheumatic Diseases; Thiamine; Vitamin B 12

Topics: Age Factors; Aged; Anemia; Anemia, Hypochromic; Arthritis, Rheumatoid; Blood Chemical Analysis; Blood Proteins; Blood Sedimentation; Bronchitis; England; Feces; Female; Folic Acid; Folic Acid Deficiency; Health Surveys; Hematologic Diseases; Hemoglobins; Hospitalization; Humans; Iron; Middle Aged; Neoplasms; Sex Factors; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Adult; Aged; Anemia, Pernicious; Arthritis, Rheumatoid; Female; Humans; Intestinal Absorption; Kidney Function Tests; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Vitamin B 12

Topics: Aged; Anemia, Macrocytic; Arthritis, Rheumatoid; Female; Gastric Juice; Humans; Middle Aged; Sjogren's Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Achlorhydria; Adult; Agammaglobulinemia; Anemia, Pernicious; Antibodies; Arthritis, Rheumatoid; Atrophy; Autoimmune Diseases; Colitis, Ulcerative; Diarrhea; Female; Fluorescent Antibody Technique; gamma-Globulins; Gastric Mucosa; Gastritis; Giardiasis; Humans; Hypersensitivity; Hypersensitivity, Delayed; Infections; Intrinsic Factor; Male; Middle Aged; Vitamin B 12

Topics: Aluminum; Animals; Arthritis, Rheumatoid; Blood Cell Count; Blood Platelets; Blood Proteins; Bone Marrow Examination; Dexamethasone; Erythrocytes; Female; Glycine; Guinea Pigs; Histological Techniques; Leukocytes; Male; Phenylbutazone; Tablets, Enteric-Coated; Thiamine; Vitamin B 12

Topics: Age Factors; Arthritis, Rheumatoid; Chronic Disease; Erythrocyte Aging; Hematologic Diseases; Humans; Reticulocytes; Sex Factors; Vitamin B 12

Topics: Arthritis, Rheumatoid; Coenzymes; Hepatitis; Hepatitis A; Humans; Liver Cirrhosis; Liver Diseases; Liver Extracts; Osteoarthritis; Sciatica; Vitamin B 12

Topics: Age Factors; Aged; Antibodies; Arthritis, Rheumatoid; Autoimmune Diseases; Complement Fixation Tests; Female; Fluorescent Antibody Technique; Gastric Mucosa; Gastritis; Hematocrit; Hemoglobins; Humans; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Schilling Test; Stomach; Vitamin B 12

Topics: Anti-Inflammatory Agents; Arthritis, Rheumatoid; Dexamethasone; Humans; Joint Diseases; Lidocaine; Osteoarthritis; Spondylitis; Thiamine; Vitamin B 12

Topics: Adult; Aged; Aminopyrine; Analgesics; Arthritis, Rheumatoid; Child; Female; Gout; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Osteoarthritis; Periarthritis; Pyridoxine; Quinolines; Vitamin B 12

Topics: Aged; Aminopyrine; Analgesics; Arthritis, Rheumatoid; Female; Herpes Zoster; Humans; Male; Neuritis; Osteoarthritis; Periarthritis; Pyridoxine; Quinolines; Spinal Diseases; Vitamin B 12

Topics: Adult; Aged; Amino Acids; Arthritis, Rheumatoid; Biliary Dyskinesia; Dyspepsia; Female; Folic Acid; Gallbladder Diseases; Gastritis; Humans; Liver Diseases; Male; Middle Aged; Niacinamide; Vitamin B 12

Topics: Adult; Aminopyrine; Analgesics; Arthritis, Rheumatoid; Female; Fever; Humans; Male; Middle Aged; Neuralgia; Pain; Pyridoxine; Quinolines; Rheumatic Fever; Urinary Tract Infections; Vitamin B 12

Topics: Anemia, Macrocytic; Arthritis, Rheumatoid; Blood; Female; Folic Acid; Folic Acid Deficiency; Humans; Male; Oxyphenbutazone; Phenylbutazone; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Arthritis; Arthritis, Rheumatoid; Cobalt; Corrinoids; Iron; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Pernicious; Anxiety; Anxiety Disorders; Arthritis; Arthritis, Rheumatoid; Bone Marrow Examination; Depression; Depressive Disorder; Drug Therapy; Humans; Neurotic Disorders; Paranoid Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Xylose

Topics: Adolescent; Analgesics; Analgesics, Non-Narcotic; Antipyretics; Arthritis; Arthritis, Rheumatoid; Geriatrics; Humans; Joint Diseases; Muscle Relaxants, Central; Orthopedics; Periarthritis; Thiamine; Traumatology; Vitamin B 12

Topics: Arthritis; Arthritis, Rheumatoid; Colloids; Eukaryota; Humans; Thiamine; Vitamin B 12; Vitamin B Complex

Topics: Adenosine Triphosphate; Arthritis; Arthritis, Rheumatoid; Humans; Neuritis; Niacin; Nicotinic Acids; Osteoarthritis; Vitamin B 12; Vitamins

Topics: Arthritis, Rheumatoid; Collagen Diseases; Corrinoids; Hematinics; Humans; Vitamin B 12

Topics: Adrenocorticotropic Hormone; Arthritis; Arthritis, Rheumatoid; Blood; Corrinoids; Cortisone; Hematinics; Pyruvates; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Antacids; Anti-Bacterial Agents; Arthritis; Arthritis, Rheumatoid; Blood Pressure; Cortisone; Dibenzylchlorethamine; Dicumarol; Epilepsy; Ergot Alkaloids; Heart Failure; Heparin; Histamine Antagonists; Humans; Hyaluronoglucosaminidase; Hydantoins; Hypersensitivity; Hypertension; Hyperthyroidism; Imidazoles; Iodine; Iodine Isotopes; Kidney; Meperidine; Mephenesin; Methadone; Motion Sickness; Norepinephrine; Organomercury Compounds; Peptic Ulcer; Tetraethylammonium; Therapeutics; Thiouracil; Thrombosis; Veratrum; Vitamin B 12