Association of Vitamin B12 and Folic Acid Levels with Disease Activity in Patients with Axial Spondyloarthritis: A Retrospective Study

Öz

Objective: It has been reported that vitamin B12 and folic acid deficiencies increase the level of homocysteine, also contribute to inflammation by unexplained mechanisms, and their blood levels vary similarly to acute phase reactants. In this retrospective study, the relationship between vitamin B12 and folic acid levels, disease activity and acute phase responses in patients with axial spondylarthritis (akSpA) was investigated. Materials and methods: Patients diagnosed with akSpA according to the ASAS/EULAR 2009 classification criteria were included in the study. Demographic data, acute phase responses, BASDAI values, vitamin B12, folic acid levels of the patients were obtained from the outpatient electronic recording system. Patients were divided into two groups as vitamin B12 levels below and above 350pg/ml. In the comparison of the groups, categorical data were made by chi-square test, numerical data were made by independent sample t-test, and correlation analysis was performed by Pearson correlation analysis. Results: 103 (57.86%) of a total of 178 akSpA patients were female and 75 were male. The mean age, vitamin B12 level and folk acid level of the patients were 43.18±11.20, 365.05±144.79 pg/ml and 8.8±6.75ng/ml, respectively. There was no statistically significant difference between the groups with high and low vitamin B12 levels, age, gender, vitamin B12, folic acid, acute phase responses and disease activity (p> 0.05). In the pearson correlation analysis, there was a weak correlation between vitamin B12 and disease activity (p:0.032). Conclusion: In this study, it was shown that there is a negative correlation between vitamin B12 levels and disease activity in akSpA patients, and there is no relationship between folic acid levels and disease activity.

Anahtar Kelimeler

• Axial spondyloarthropathy
• Vitamin B12
• Folic Acid.

Aksiyal Spondiloartrit Hastalarında Vitamin B12 ve Folik Asit Seviyelerinin Hastalık Aktivitesi ile İlişkisi: Retrospektif Bir Çalışma

Öz

Amaç: B12 vitamini ve folik asit eksikliklerinin, homosistein düzeyini arttırdıkları, ayrıca tam olarak açıklanamayan mekanizmalarla inflamasyona katkıda bulundukları ve kandaki düzeylerinin akut faz reaktanlarına benzer şekilde değişiklik gösterdiği bildirilmiştir. Bu retrospektif çalışmada aksiyal spondilartrit (akSpA) hastalarında vitamin B12 ve folik asit düzeyleri ile hastalık aktivitesi ve akut faz yanıtları arasındaki ilişki araştırılmıştır. Gereç ve yöntem: Çalışmaya ASAS/EULAR 2009 sınıflama kriterlerine göre akSpA tanısı almış hastalar alındı. Hastaların demografik verileri, akut faz yanıtları, BASDAI değerleri, vitamin B12, folik asit düzeyleri poliklinik elektronik kayıt sisteminden elde edildi. Hastalar vitamin B12 düzeyleri 350 pg/ml altı ve 350 pg/ml üstü olarak iki gruba ayrıldı. Grupların karşılaştırılmasında kategorik veriler ki-kare testi, sayısal veriler bağımsız örneklem t-testi, korelasyon analizi pearson korelasyon analizi ile yapıldı. Bulgular: Toplam 178 akSpA hastasının 103’ü (%57.86) kadın ve 75’i erkek idi. Hastaların ortalama yaş, vitamin B12 ve folk asit düzeyleri sırasıyla 43.18±11.20, 365.05±144.79 pg/ml ve 8.8±6.75ng/ml idi. Vitamin B12 düzeyi yüksek ve düşük olan gruplar arasında; yaş, cinsiyet, vitamin B12, folik asit, akut faz yanıtları ve hastalık aktivitesi arasında istatistiksel olarak anlamlı fark yoktu (p> 0.05). Yapılan pearson korelasyon analizinde vitamin B12 ile hastalık aktivitesi arasında zayıf bir korelasyon vardı (p:0.032). Sonuç: Bu çalışmada akSpA hastalarında vitamin B12 düzeyleri ile hastalık aktivitesi arasında negatif yönlü bir korelasyonun olduğu, ayrıca folik asit düzeyleri ile hastalık aktivitesi arasında bir ilişki olmadığı gösterilmiştir.

Anahtar Kelimeler

• Aksiyal Spondiloartrit
• Vitamin B12
• Folik Asit
• BASDAI

Kaynakça

1. 1. Arturi P, Schneeberger EE, Sommerfleck F, et al. Adherence to treatment in patients with ankylosing spondylitis. Clin Rheumatol. 2013;32(7):1007-15.
2. 2. Kwan YH, Tan JJ, Phang JK, Fong W. Validity and reliability of the Ankylosing Spondylitis Disease Activity Score with C-reactive protein (ASDAS-CRP) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in patients with axial spondyloarthritis (axSpA) in Singapore.Int J Rheum Dis. 2019;22(12):2206-12.
3. 3. Machado P, Landewé R. Is it time to replace BASDAI with ASDAS? Nat Rev Rheumatol. 2013;9(7):388-90.
4. 4. Langan RC, Goodbred AJ. Vitamin B12 Deficiency: Recognition and Management. Am Fam Physician. 2017;96(6):384-9.
5. 5. Ratajczak AE, Szymczak-Tomczak A, Rychter AM. Does Folic Acid Protect Patients with Inflammatory Bowel Disease from Complications? Nutrients.2021;13(11).
6. 6. Sijilmassi O. Folic acid deficiency and vision: a review.Graefes Arch Clin Exp Ophthalmol. 2019;257(8):1573-80.
7. 7. Lin X, Meng X, Song Z. Homocysteine and psoriasis. Biosci Rep. 2019;39(11).
8. 8. Vanizor Kural B, Orem A, Cimşit G, Uydu HA, Yandi YE, Alver A. Plasma homocysteine and its relationships with atherothrombotic markers in psoriatic patients. Clin Chim Acta. 2003;332(1-2):23-30.

9. 9. Brazzelli V, Grasso V, Fornara L, Moggio E, Gamba G, Villani S, et al. Homocysteine, vitamin B12 and folic acid levels in psoriatic patients and correlation with disease severity. Int J Immunopathol Pharmacol. 2010;23(3):911-6.
10. 10. Wang N, Tang H, Wang X, Wang W, Feng J. Homocysteine upregulates interleukin-17A expression via NSun2-mediated RNA methylation in T lymphocytes. Biochem Biophys Res Commun. 2017;493(1):94-9
11. 11. Dilek Oztas SE, Ali Benzil, Osman Nadar, , Ozcan Erel. A New Inflammatory Marker: Vitamin B12. J Immunol Clin Microbiol. 2019;4(1):1-12.
12. 12. Park S, Johnson MA. What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status? Nut Rev. 2006;64(8):373-8
13. 13. Poddubnyy D. Classification vs diagnostic criteria: the challenge of diagnosing axial spondyloarthritis. Rheumatology (Oxford, England). 2020;59(Suppl4):iv6-iv17.
14. 14. Harrison SR, Li D, Jeffery LE, Raza K, Hewison M. Vitamin D, Calcif Tissue Int. 2020;106(1):58-75.
15. 15. Vreugdenhil G, Wognum AW, van Eijk HG, Swaak AJ. Anaemia in rheumatoid arthritis: the role of iron, vitamin B12, and folic acid deficiency, and erythropoietin responsiveness. Ann Rheum Dis. 1990;49(2):93-8.
16. 16. Shipton MJ, Thachil J. Vitamin B12 deficiency - A 21st century perspective,Clin Med (Lond). 2015;15(2):145-50.
17. 17. Cakmak SK, Gül U, Kiliç C,ve ark. Homocysteine, vitamin B12 and folic acid levels in psoriasis patients. J Eur Acad Dermatol Venereol. 2009;23(3):300-3.
18. 18. Li HH, Li XQ, Sai LT, Cui Y, Xu JH, Zhou C, et al. Association of homocysteine with ankylosing spondylitis: a systematic review and meta-analysis, Adv Rheumatol. 2021;61(1):17.
19. 19. Yxfeldt A, Wållberg-Jonsson S, Hultdin J, Rantapää-Dahlqvist S. Homocysteine in patients with rheumatoid arthritis in relation to inflammation and B-vitamin treatment. Scand J Rheumatol. 2003;32(4):205-10.