Evaluation of serum magnesium, lipid profile and various biochemical parameters as risk factors of cardiovascular diseases in patients with rheumatoid arthritis

Iron, copper, zinc and magnesium on rheumatoid arthritis: a two-sample Mendelian randomization study

This study aimed to elucidate the causal genetic relationships between iron, copper, zinc, magnesium, and rheumatoid arthritis (RA). A two-sample Mendelian randomization (MR) analysis was conducted using the "TwoSampleMR" and "MendelianRandomization" packages in R. The random-effects inverse variance-weighted (IVW) method was used as the primary approach. We performed sensitivity analyses to test the reliability of the results. The random-effects IVW analysis revealed that there was no genetic causal relationship between iron (P = 0.429, odds ratio [OR] 95% confidence interval [CI] = 0.919 [0.746-1.133]), copper (P = 0.313, OR 95% CI = 0.973 [0.921-1.027]), zinc (P = 0.633, OR 95% CI = 0.978 [0.891-1.073]), or magnesium (P = 0.218, OR 95% CI = 0.792 [0.546-1.148]) and RA. Sensitivity analysis verified the reliability of the results. Therefore, there is no evidence to support a causal relationship between iron, copper, zinc, and magnesium intake at the genetic level and the development of RA.

Lipid metabolism and rheumatoid arthritis

As a chronic progressive autoimmune disease, rheumatoid arthritis (RA) is characterized by mainly damaging the synovium of peripheral joints and causing joint destruction and early disability. RA is also associated with a high incidence rate and mortality of cardiovascular disease. Recently, the relationship between lipid metabolism and RA has gradually attracted attention. Plasma lipid changes in RA patients are often detected in clinical tests, the systemic inflammatory status and drug treatment of RA patients can interact with the metabolic level of the body. With the development of lipid metabolomics, the changes of lipid small molecules and potential metabolic pathways have been gradually discovered, which makes the lipid metabolism of RA patients or the systemic changes of lipid metabolism after treatment more and more comprehensive. This article reviews the lipid level of RA patients, as well as the relationship between inflammation, joint destruction, cardiovascular disease, and lipid level. In addition, this review describes the effect of anti-rheumatic drugs or dietary intervention on the lipid profile of RA patients to better understand RA.

Serum chemerin and visfatin levels and their ratio as possible diagnostic parameters of rheumatoid arthritis

Objectives

Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovium and articular cartilage that initiates joint damage. Rheumatoid arthritis is associated with a change in many inflammatory biomarkers. The present study aims to examine the diagnostic ability of inflammatory adipocytokines (chemerin and visfatin) and their ratio for RA disease.

Material and methods

The study recruited 60 RA patients and 30 healthy controls. Serum visfatin and chemerin were measured using the ELISA technique. Some related parameters including body mass index (BMI), lipid profile components, C-reactive protein (CRP), and uric acid levels were also determined and correlated with the level of these adipokines.

Results

Serum chemerin, visfatin, CRP, and uric acid (UA) levels were significantly higher (p< 0.05) in RA patients than those of the control group. The multivariate general linear model (GLM) analysis showed that 70.7% of the change in the level of measured parameters can be explained by the presence of RA disease (partial η² = 0.707, p< 0.001). To explore which parameter was affected by the diagnosis, the results of tests between subjects showed that all biomarkers were affected significantly by the diagnosis and the greater effects were on CRP (partial η² = 0.480, p< 0.001) followed by chemerin (partial η² = 0.295, p< 0.001), while visfatinshowed partial η² = 0.079 only. Chemerin showed the highest sensitivity (88.1%) and specificity (75.9%) for diagnosis of RA at cut-off concentration = 187.88 ng/ml as compared with other parameters.

Conclusions

Chemerin and visfatin levels are affected by RA disease when adjusted for other cofounders. The present results suggest that serum chemerin can be used as an inflammatory marker of RA patients as it has good sensitivity and specificity.

The role of magnesium in different inflammatory diseases

Magnesium deficiency (MgD) can cause inflammation in human body. The known mechanisms of inflammation caused by MgD include activation of phagocytic cells, opening of calcium channels, activation of the N-methyl-D-aspartate (NMDA) receptor, and activation of nuclear factor (NF)-κB. In addition, MgD causes systemic stress response through neuroendocrinological pathways. The inflammation caused by MgD can result in pro-atherogenic changes in the metabolism of lipoproteins, endothelial dysfunction, and high blood pressure. Studies suggest that magnesium may play an important role in the pathophysiology of some inflammatory diseases. Several clinical trials and laboratory studies have been done on the functional role of magnesium. In this study, we review some inflammatory diseases, in which the magnesium has a role in their pathophysiology. Among these diseases, diabetes, asthma, preeclampsia, atherosclerosis, heart damage, and rheumatoid arthritis have been highlighted.

Efficacy and Safety of 22-Oxa-Calcitriol in Patients with Rheumatoid Arthritis: A Phase II Trial

BACKGROUND Calcitriol (1 alpha, 25-dihydroxy vitamin D3) is a good vitamin D supplement but can cause hypercalcemia. Whereas, 22-oxa-1 alpha, 25-dihydroxy vitamin D3 (22-oxa-calcitriol) has less hypercalcemic activity than calcitriol and is reported to be effective for cell-proliferative diseases. The objective of the study was to compare renal function and blood tests of arthritis patients receiving calcitriol supplements with those receiving 22-oxa-calcitriol supplements. MATERIAL AND METHODS A total of 369 patients with clinically confirmed rheumatoid arthritis were included in this phase II trial. Patients received lactose powder (the placebo group, n=123), 50 000 IU/week of 22-oxa-calcitriol (the treatment group, n=123), or 50 000 IU/week of calcitriol (the control group, n=123) for 6 weeks. At the time of enrollment and after 6 weeks of supplementation, renal function tests, blood tests, and secondary outcome measures were evaluated. One-way ANOVA and the chi-squared test for independence were performed for continuous data and constant data at a 95% of confidence level. RESULTS Both 22-oxa-calcitriol and calcitriol successfully decreased swollen joints in patients with rheumatoid arthritis, and both improved Health Assessment Questionnaire Disease Activity Index scores and serum vitamin D levels. The intensity of improvement of serum vitamin D levels in both groups was the same (P<0.0001, q=0.24); however, calcitriol caused hypercalcemia (P<0.0001, q=12.59). CONCLUSIONS This study found that 22-oxa-calcitriol was a good option for vitamin D supplementation in rheumatoid arthritis patients.