Does stress response axis activation differ between patients with autoimmune disease and healthy people?

Many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal (HPA) axis, but the results are controversial. Our objective was to study differences in stress response axis activity between patients with autoimmune disease and healthy people. The study sample consisted of 97 women divided into four groups: 37 healthy women (HW), 21 with systemic lupus erythematosus (SLE), 21 with Sjögren's syndrome (SS), and 18 with systemic sclerosis (SSc). After being exposed to a stress task, participants' skin conductance and salivary cortisol levels were measured in order to assess their response to psychological stress. Diurnal cortisol concentrations were assessed by measuring salivary cortisol in samples collected five times over one day. In addition, self-administered questionnaires were used to assess psychological variables. A time × group interaction effect was found (p = 0.003) in salivary cortisol secretion in response to stressful challenge. The healthy group presented normal activation, the SS and SLE groups showed no activation, and the SSc group presented a similar activation pattern to the HW group, except at the time of recovery. Total cortisol production (AUCg) was higher in the SSc group than in the HW group (p = 0.001). Differences were also observed in the cortisol AUCg collected over one day between healthy women and patients with SLE (p = 0.004) as well as with SSc (p = 0.001): women with SLE and SSc presented higher total hormone production than healthy women. Patients with autoimmune disease present a different HPA axis response, which may contribute to the harmful effects of stress in these diseases.

[Scales for social support for eating habits and exercise: psychometric properties]. / Escalas de apoyo social para los hábitos alimentarios y para el ejercicio: propiedades psicométricas.

OBJECTIVE: Social support can introduce favorable changes in lifestyle to reduce the cardiovascular risk. The aim of this study was to verify these changes in the clinical population participating in this study and present the psychometric properties of the scales of social support for 'Eating Habits' and 'Exercise' in patients diagnosed with metabolic syndrome. METHODS: 135 participants attending a programme for changing lifestyle habits. Sociodemographic, psychological, and lifestyle variables were assessed at the Hospital Universitario Virgen de las Nieves (HUVN) in Granada (Spain) between 2013 and 2014. The following procedures were used: Confirmatory factor analysis (CFA), internal consistency, sensibility to change and temporal stability. RESULTS: The AFC confirmed the original structure of both scales, except for the exclusion of factor 2 (family) from the social support scale for the year. For the social support scale, the local adjustment, all items presented high values of factor loads and individual reliability (λ≥0.64 and R2≥0.41, respectively). For the exercise scale, the local adjustment, the items presented high values of factor loads and individual reliability (λ≥0.62 and R2≥0.38, respectively). Internal consistency values were between adequate and excellent, with Cronbach's alpha figures between 0.714 and 0.864. Regarding sensitivity to change, the experimental group increased the perception of social support for food and exercise. The control group did not show significant differences. CONCLUSIONS: Our results show adequate indices for validity and reliability of the measures. Both measures appeared to be useful to assess social support in patients diagnosed with metabolic syndrome.

OBJETIVO: El apoyo social puede introducir cambios favorables en el estilo de vida de cara a reducir el riesgo cardiovascular. El objetivo de este estudio fue verificar dichos cambios en la población clínica que participó en el mismo y presentar las propiedades psicométricas de dos escalas de apoyo social: los hábitos alimentarios y el ejercicio. Ambas fueron aplicadas en pacientes con síndrome metabólico (SM). METODOS: Participaron 135 sujetos en un programa de modificación de estilo de vida. Las medidas sociodemográficas, psicológicas y de estilo de vida fueron tomadas en el Hospital Universitario Virgen de las Nieves (HUVN) de Granada (España) durante 2013 y 2014. Se realizaron los siguientes análisis: análisis factorial confirmatorio(AFC), de la consistencia interna, de la sensibilidad al cambio y de la estabilidad temporal. RESULTADOS: El AFC confirmó la estructura original de ambas escalas, excepto por la exclusión del factor 2 (familia) de la escala de apoyo social para el ejercicio. Para la escala de apoyo social, el ajuste local, todos los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (λ≥0,64 y R2≥0,41, respectivamente). Para la escala de ejercicio, el ajuste local, los ítems presentaron altos valores de cargas factoriales y fiabilidades individuales (λ≥0,62 y R2≥0,38, respectivamente). Los valores de consistencia interna resultaron entre adecuados y excelentes, con cifras de alfa de Cronbach entre 0,714 y 0,864. En cuanto a la sensibilidad al cambio, el grupo experimental aumentó la percepción del apoyo social para la alimentación y para el ejercicio. El grupo de control no presentó diferencias significativas. CONCLUSIONES: Los resultados muestran niveles adecuados de validez y fiabilidad, demostrando que las escalas son adecuadas para evaluar el apoyo social en pacientes con SM.

Thrombotic microangiopathy in a patient with eosinophilic granulomatosis with polyangiitis: case-based review.

The correct diagnosis, classification and therapeutic management of thrombotic microangiopathies (TMA) continue to be a challenge for the clinician. We report a rare case of eosinophilic granulomatosis with polyangiitis (EGPA) as a trigger for complement-mediated TMA in a 57-year-old man who was successfully treated with corticoids, cyclophosphamide and therapeutic plasma exchange. Additionally, we review few other cases reported in the literature and the pathophysiological pathway of association between TMA and EGPA. We found that the mutual relationships between the inflammation triggered by vasculitis, the exacerbated complement activation, together with hypereosinophilia and endothelial damage seem to be the key in explaining the connection between both entities. We suggest that an understanding of the multi-causal nature of TMAs is crucial for the correct diagnosis and treatment of these patients.

[Validity and reliability of the self-efficacy to regulate exercise scale in patients with metabolic syndrome]. / Validez y fiabilidad de la escala de autoeficacia para el ejercicio físico en pacientes con síndrome metabólico.

OBJECTIVE: Self-efficacy refers to beliefs in individuals' own capacities to do something. With the intent of evaluate the validity and reliability, we investigated the psychometric properties of the Self-Efficacy to Regulate Exercise Scale (SERES) in patients with metabolic syndrome (MetS). METHODS: 135 participants with medical diagnosis of MetS took part in the study (Mage=55.5, SD=7.6). We investigated sociodemographic, psychological, and life-style variables. Participants were recruited at the Hospital Universitario Virgen de las Nieves (HUVN) in Granada (Spain) between 2013 and 2014. In order to characterise the sample, descriptive statistics were used. Factorial analysis, internal consistency and convergent reliability of the SERES were also calculated. Group differences were investigated using Student's t test. RESULTS: A solution with two factors was extracted, which explained 72.7% of the variance of the SERES. The internal consistency values for the total score of the SERES were (0.925 and 0.864) according to the values of Cronbach's alpha and Guttman's two halves, respectively. Significant correlations of the SERES were detected for with physical exercise, assertiveness, stress, anger, and active life-style (e.g., renouncing to sedentary behaviours). CONCLUSIONS: This was the first study to report on psychometric properties of the SERES. Results supported the adequacy of the measure for use with patients with MetS. SERES seemed to be useful in evaluating self-efficacy in relation to physical exercise, psychosocial, and lifestyle variables.

OBJETIVO: La autoeficacia percibida se refiere a la creencia en la propia capacidad para hacer algo. El objetivo de este trabajo fue obtener la validez y la fiabilidad de la escala de autoeficacia para el ejercicio físico (AEEF) en pacientes con síndrome metabólico (SM) y para ello fueron verificadas las propiedades psicométricas de la misma. METODOS: Participaron en el estudio 135 sujetos con una edad media de 55,5 años (DT=7,6) que cumplían los criterios diagnósticos para el SM. Se tomaron medidas sociodemográficas, psicológicas y de estilo de vida de los mismos. Los sujetos fueron reclutados en el Hospital Universitario Virgen de las Nieves (HUVN) de Granada (España) durante los años de 2013 a 2014. La caracterización de la muestra fue realizada a través de análisis descriptivos. Se realizó el análisis factorial, de la consistencia interna y de validez convergente del AEEF; las diferencias intra e intergrupales fueron evaluadas a través de la prueba t de Student. RESULTADOS: Extrajimos una solución de 2 factores que explicaron el 72,7% de la varianza común. Los valores de consistencia interna para la puntuación total de la AEEF fueron de (0,925 y 0,864) según los valores del alfa de Cronbach y del método de las dos mitades de Guttman, respectivamente. Las correlaciones de la AEEF con la frecuencia de la práctica de ejercicios, la renuncia al sedentarismo, la asertividad, el estrés y la ira fueron estadísticamente significativas. CONCLUSIONES: Este es el primer estudio sobre las propiedades psicométricas de la versión española de la AEEF. Los resultados mostraron niveles aceptables de validez y fiabilidad en pacientes con SM. La escala demostró ser útil para evaluar la asociación de la autoeficacia relativa al ejercicio físico con distintas variables psicosociales y de estilo de vida.

Association between perceived level of stress, clinical characteristics and psychopathological symptoms in women with systemic lupus erythematosus.

OBJECTIVES: To evaluate psychopathological status and stress level from a sample with SLE; compare mental functioning and stress levels between women with SLE and healthy women; determine whether disease duration, disease activity, cumulative organ damage and stress have an influence on psychopathological symptoms in SLE patients; and evaluate whether perception of stress is related to SLE severity. METHODS: We conducted a cross-sectional study of 425 participants; 202 women with SLE, with an average age (SD) of 36.61 (10.15), and 223 healthy women, with age-matched controls. The assessment included the clinical characteristics (disease duration, SLE activity, cumulative organ damage, pharmacotherapy), the Symptom Checklist-90-Revised (SCL-90-R) and the Perceived Stress Scale. Descriptive, comparative, univariate and multivariate analysis were performed. RESULTS: SLE patients showed psychopathological alterations in the somatisation, obsessive-compulsive and positive discomfort subscales of SCL-90-R. Women with SLE reported significantly higher scores on the psychopathological dimensions and perceived stress compared to healthy women, except for paranoid ideation. Disease duration, SLE activity, cumulative organ damage, and perceived stress were shown to be significant predictors of psychopathological manifestations, explaining a range, between 20 and 43%, of variance across SCL-90-R dimensions. Moreover, perceived stress was related to SLE activity, after controlling for psychopathological dimensions. CONCLUSIONS: The psychopathological manifestations in SLE appeared to be influenced by perceived stress, disease duration, disease activity and cumulative organ damage. In turn, perceived stress was associated with disease severity. This knowledge may contribute to a more comprehensive perspective of these manifestations in the SLE population in the clinical setting.

Adherence to treatment in patients with systemic lupus erythematosus. / Adherencia al tratamiento en pacientes con lupus eritematoso sistémico.

BACKGROUND AND OBJECTIVE: Non-adherence to treatment is usually a clinical problem in patients with systemic lupus erythematosus (SLE). Increasing the knowledge of predictors of treatment adherence can be meaningful in the clinical setting. The main objective of the present study was to analyse the influence of sociodemographic, clinical and psychological variables on the degree of treatment adherence in a sample of Spanish women with SLE. PATIENTS AND METHOD: This is an observational-transversal study. All participants were evaluated for the degree of treatment adherence, their clinical status, psychopathological manifestations, the level of perceived stress and self-efficacy. The sample was divided into two groups (adherent vs non-adherent). The factors associated with a lack of adherence in this sample were analysed by means of logistic regression. RESULTS: This study comprises 72 women with SLE (average age=36.72±12.2 years). Almost 64% of patients with SLE were non-adherent to treatment. The results showed that a low educational level, being unemployed, living with a partner and alcohol abuse were associated with low treatment adherence. There were significant mean differences between groups in psychopathological subscales of somatisation, obsession-compulsion and general psychopathological indices. There were also mean differences between groups for the level of perceived stress. The use of non-steroidal anti-inflammatory drugs, suffering arthrosis and scoring higher in dimensions of psychopathology were significant predictors of treatment adherence, explaining between 35% and 47% of its variability. CONCLUSIONS: Including the clinical and psychopathological manifestations as important aspects in the clinical reasoning of health professionals could improve the adherence to treatment of patients with SLE.

Effect of ethnicity on clinical presentation and risk of antiphospholipid syndrome in Roma and Caucasian patients with systemic lupus erythematosus: a multicenter cross-sectional study.

AIM: To determine if there are ethnic differences in the prevalence of antiphospholipid syndrome (APS), clinical presentation and autoantibody profile between Roma and Caucasian patients with systemic lupus erythematosus (SLE). METHOD: A cross-sectional study was conducted including data from Roma and Caucasian SLE patients consecutively attending six hospitals in Spain. Socio-demographic characteristics, prevalence of APS, clinical and analytical features of SLE and APS were compared between ethnic groups. RESULTS: Data from 52 Roma and 98 Caucasian SLE patients were included. Roma SLE patients had a higher risk (odds ratio 2.56, 95% CI 1.02-6.39) and prevalence of APS (28.8% vs. 13.3%, P = 0.027). Furthermore, Roma SLE patients had a statistically significant higher prevalence of abortions (23.5% vs. 10.2%, P = 0.049). In relation to other APS diagnostic criteria, Roma SLE patients had a non-statistically significant higher prevalence of fetal deaths (14.3% vs. 5.1%, P = 0.106) and thrombotic events (21.1% vs. 12.2%, P = 0.160). In relation to SLE clinical features, Roma patients had a significantly higher prevalence of arthritis (75% vs. 57.1%, P = 0.034) and non-significant higher prevalence of serositis (44.2% vs. 29.6%, P = 0.104), discoid lesions (11.5% vs. 5.1%, P = 0.191), oral ulcers (46.1% vs. 34.7%, P = 0.218) and livedo reticularis (21.1% vs. 15.3%, P = 0.374). No statistically significant differences were found in the Systemic Lupus International Collaborating Clinics Damage Index or the autoimmune serological profile. CONCLUSION: Prevalence and risk of APS were significantly higher in Roma SLE patients. Furthermore, Roma patients had a significantly higher prevalence of abortions and a non-significant higher prevalence of fetal deaths and thrombotic events.

Stress, anger and Mediterranean diet as predictors of metabolic syndrome. / Estrés, ira y dieta mediterránea como factores predictores del síndrome metabólico.

BACKGROUND AND OBJECTIVE: Metabolic syndrome (MetS) is a cluster of metabolic conditions that include abdominal obesity, reduction in cholesterol concentrations linked to high density lipoproteins (HLDc), elevated triglycerides, increased blood pressure and hyperglycaemia. Given that this is a multicausal disease, the aim of this study is to identify the psychological, emotional and lifestyle variables that can have an influence on the different MetS components. PATIENTS AND METHODS: A cross-sectional study with 103 patients with diagnostic criteria for MetS (47 male and 56 female). Anthropometric, clinical and analytical measurements were collected to assess the variables associated with MetS. The main psychological and emotional variables were also assessed. RESULTS: Different multiple linear regression tests were performed to identify which variables were predictive of MetS. The dependent variables were body mass index (BMI), abdominal circumference, HDLc, and quality of life, and the predictive variables were psychological stress, anger and adherence to a Mediterranean diet. The results showed that psychological stress was a predictor of quality of life (ß=-0.55, P≤0). Similarly, anger was a predictor of BMI (ß=0.23, P=.047) and abdominal circumference (ß=0.27, P=.021). As expected, adherence to a Mediterranean diet was a predictor of HDLc (ß=0.2, P=.045) and of quality of life (ß=-0.18, P=.031). CONCLUSIONS: The results confirm a link between adherence to certain dietary habits and lifestyle, however they go one step further and show the importance of psychological and emotional factors like psychological stress and anger in some MetS components.

Analyses of hair and salivary cortisol for evaluating hypothalamic-pituitary-adrenal axis activation in patients with autoimmune disease.

Although many studies have shown that patients with autoimmune disease present a hypoactive hypothalamic-pituitary-adrenal axis (HPA), controversial results have been described. Our objective was to study HPA axis activity in women with autoimmune disease compared to healthy women. Therefore, we analyzed salivary cortisol over the course of a day, and hair cortisol concentrations from the three preceding months, from 65 women divided into two groups: healthy women (n = 30), with a mean age of 44.70 ± 11.65 years; and women with autoimmune disease (n = 35), with a mean age of 48.26 ± 9.04 years. The latter group comprises women with systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), and systemic sclerosis (SSc). Perceived stress and psychopathological symptomatology were also evaluated. Autoimmune disease group scored higher on the somatization subscale SCL-90-R and lower on the anxiety subscale than the control group. Regarding HPA axis activation, the area under curve for cortisol levels during the day was higher for the autoimmune disease group. In addition, higher cortisol levels in hair were found in the group with autoimmune disease. Our findings show greater short and long-term HPA axis activity in women with autoimmune disease than in healthy women.

Relationship between QT Interval Length and Arterial Stiffness in Systemic Lupus Erythematosus (SLE): A Cross-Sectional Case-Control Study.

INTRODUCTION AND OBJECTIVES: The QT interval on the electrocardiogram has been shown to be longer in patients with systemic lupus erythematosus (SLE) compared to that of the general population. The clinical significance of this finding is unknown. The aim of this study was to assess the relationship between QT interval and subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. MATERIAL AND METHODS: 93 patients with SLE and 109 healthy women with similar basal characteristics were studied. All patients underwent a 12- lead electrocardiogram, and corrected QT interval (QTc) was measured using the Bazett's formula. The presence of atherosclerosis was evaluated by carotid-femoral pulse-wave velocity. RESULTS: Clinical basal characteristics were similar in both groups. QTc interval was 415 ± 21.4 milliseconds in all patients, and 407 ± 19.1 milliseconds in the control group (p = 0.007). There was a positive correlation between QTc interval and carotid-femoral pulse-wave velocity (r = 0.235; p = 0.02) in patients with SLE. This association was independent of hypertension and age in a multivariate analysis. CONCLUSION: QTc interval measured by electrocardiogram is prolonged in SLE patients; it is related to subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. This measure may help stratify risk in routine clinical practice and select the patients that might benefit from a more aggressive therapy in the prevention of cardiovascular events.

Patterns of drug therapy in newly diagnosed Spanish patients with systemic lupus erythematosus.

OBJECTIVES: This is the first Spanish multicentric inception lupus cohort, formed by SLE patients attending Spanish Internal Medicine Services since January 2009. We aimed to analyse drug therapy during the first year of follow-up according to disease severity. METHODS: 223 patients who had at least one year of follow-up were enrolled upon diagnosis of SLE. Therapy with prednisone, pulse methyl-prednisolone, hydroxychloroquine, immunosuppressives and calcium/vitamin D was analysed. RESULTS: Prednisone was given to 65% patients, at a mean (SD) daily dose of 11 (10) mg/d. 38% patients received average doses >7.5 mg/d during the first year. Patients with nephritis and with a SLEDAI ≥6 were treated with higher doses of prednisone. 81% of patients were treated with hydroxychloroquine, with higher frequency among those with a SLEDAI ≥6 (88% vs. 68%, p<0.001). The use of immunosuppressive drugs and methyl-prednisolone pulses was higher in patients with a baseline SLEDAI ≥6, however, differences were no longer significant when patients with lupus nephritis were excluded. The use of calcium/vitamin D increased with the dose of prednisone, however, 43% of patients on medium-high doses of prednisone did not take any calcium or vitamin D. CONCLUSIONS: This study gives a real-world view of the current therapeutic approach to early lupus in Spain. The generalised use of hydroxychloroquine is well consolidated. There is still a tendency to use prednisone at medium to high doses. Pulse methyl-prednisolone and immunosuppressive drugs were used in more severe cases, but not as steroid sparing agents. Vitamin D use was suboptimal.

Cumulated organ damage is associated with arterial stiffness in women with systemic lupus erythematosus irrespective of renal function.

OBJECTIVES: To determine whether there is an association between cumulated organ damage and arterial stiffness in women with systemic lupus erythematosus (SLE) with normal renal function and without renal damage. METHODS: Eighty-eight SLE women with normal renal function and without renal damage, and 102 sex- and age-matched controls with no history of coronary heart disease or peripheral arterial disease were studied. Cumulated organ damage and arterial stiffness were measured using the SLICC/ACR Damage Index (SDI) and pulse wave velocity (PWV), respectively. Patients were categorised as with (SDI ≥1) or without cumulated organ damage (SDI=0) and bivariate analyses were performed to compare both groups. A multivariate logistic regression was carried out to analyse the independent factors associated with cumulated organ damage. A multiple linear regression analysis was used to investigate the correlation between SDI and PWV, adjusted for appropriate confounders. RESULTS: PWV was significantly higher in patients with respect to controls (p=0.007). Also, patients with SDI ≥1 had significantly higher PWV than those with SDI=0 (p=0.007). In the multivariate analysis, cumulated organ damage was significantly associated with PWV (p=0.006) and obesity (p=0.003). Furthermore, PWV correlated with SDI after adjustment for age, SLE duration, systolic blood pressure, body mass index, renal function, prednisone and homocysteine (r=0.283, p=0.011). Patients with increased PWV were more likely to have organ damage (SDI ≥1) than those with normal PWV (67% vs. 36%, p=0.023). CONCLUSIONS: Cumulated organ damage was found to be independently associated with the arterial stiffness in SLE women without renal involvement.

Nighttime Blood Pressure Patterns and Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus.

OBJECTIVE: To compare 24-h ambulatory blood pressure (BP) monitoring (ABPM) values and patterns in women with systemic lupus erythematosus (SLE) with those of a matched control group and their relationship with the presence of subclinical atherosclerosis. METHODS: ABPM was assessed in 70 women with SLE and in 65 sex- and age-matched controls without a history of clinic cardiovascular disease (CVD). Carotid-femoral pulse wave velocity (PWV), which is a marker of subclinical atherosclerosis and a predictor of future CVD, was measured. Multivariate logistic analysis was used to determine which explanatory variables were independently associated with the non-dipper pattern and the presence of nocturnal hypertension (HTN) in women with SLE. RESULTS: No differences in PWV were found between patients and controls [median 7.3, interquartile range (IQR) 6.5-8.1 m/s vs median 7.1, IQR 6.5-7.8 m/s, p = 0.474]. The frequency of nondipper pattern (p = 0.025) and nocturnal HTN (p = 0.004) was significantly higher in women with SLE than in controls. White-coat and masked HTN were present in 10% and 11% of patients and in 20% and 8% of controls, respectively (p > 0.05 in all cases). The concordance between office and ambulatory HTN in the SLE and control groups was modest (κ = 0.325 and κ = 0.451, respectively). PWV and chronic kidney disease, and PWV and the Systemic Lupus Erythematosus Disease Activity Index were found to be independently associated with nocturnal HTN and nondipper pattern, respectively. CONCLUSION: Women with SLE were more likely to have an altered nighttime BP pattern than controls. In women with SLE, nondipper pattern and nocturnal HTN were independently associated with increased subclinical atherosclerosis measured by PWV.

Prevalence of and factors associated with increased arterial stiffness in patients with primary Sjögren's syndrome.

OBJECTIVE: To compare the presence of subclinical atherosclerosis measured by means of pulse wave velocity (PWV) in women with primary Sjögren's syndrome (SS) versus a healthy age- and sex-matched control group, and to identify factors independently associated with PWV in primary SS. METHODS: Forty-four women with primary SS and 78 age-matched healthy women without overt cardiovascular (CV) diseases were assessed for traditional and nontraditional CV risk factors. PWV was also performed. A linear regression analysis was used to identify factors independently associated with PWV in primary SS. RESULTS: Women with primary SS had significantly higher PWV than controls (P = 0.030), and the frequency of increased PWV was significantly higher in this group (25% versus 8%; P = 0.013). The proportion of patients ages ≤50 years (ratio 4.6) with increased PWV was almost 2-fold higher than those ages >50 years (ratio 2.4) with respect to controls. Positivity for anti-SSB was more frequent in patients with normal PWV than in those with increased PWV (61% versus 18%; P = 0.034). Women with primary SS and increased PWV had lower levels of 25-hydroxyvitamin D (25[OH]D; P = 0.047) than primary SS patients with normal PWV. In addition, 25(OH)D levels tended to correlate inversely with PWV in women with primary SS (P = 0.067), but not in controls (P = 0.97). In multivariate analysis, the Framingham Risk Score (FRS) and Sjögren's Syndrome Damage Index emerged as factors independently correlated with PWV. CONCLUSION: Women with primary SS had higher PWV than controls, but a similar FRS. The FRS and chronic damage were found to be independently associated with PWV.

Relationship between homocysteine levels and hypertension in systemic lupus erythematosus.

OBJECTIVE: Homocysteine has been linked to atherosclerosis and hypertension (HT) in the general population. However, there is limited evidence regarding the effect of homocysteine on blood pressure and arterial stiffness in systemic lupus erythematosus (SLE). We examined whether homocysteine is associated with HT and arterial stiffness in women with SLE. METHODS: In total, 99 women with SLE without a history of cardiovascular disease or diabetes mellitus and 101 matched controls were included in this cross-sectional study. Participants were analyzed for homocysteine levels, cardiovascular risk factors, and arterial stiffness assessed by means of carotid-femoral pulse wave velocity (PWV). Associations between homocysteine, systolic blood pressure (SBP), PWV, and HT were tested using univariate and multivariate analyses. RESULTS: Homocysteine levels (mean ± SD 12.3 ± 4.8 versus 9.3 ± 3.8 µmoles/liter), PWV (mean ± SD 7.54 ± 1.1 versus 7.10 ± 1.1 meters/second), SBP (mean ± SD 119 ± 13 versus 115 ± 12 mm Hg), and the prevalence of hyperhomocysteinemia (23% versus 7%) and HT (43% versus 12%) were significantly higher in women with SLE (P < 0.050 for all). In the univariate analysis, homocysteine correlated positively with SBP (P = 0.001) and PWV (P = 0.023) in women with SLE but not in controls. In the multiple linear regression analysis, SBP was independently associated with homocysteine and body mass index (BMI) in women with SLE. Similarly, in the multivariate logistic regression analysis, homocysteine levels (or hyperhomocysteinemia), BMI, and daily prednisone dose were independently associated with HT in women with SLE. CONCLUSION: Homocysteine was independently associated with SBP and HT in women with SLE, but not in controls. Elevated homocysteine levels could increase the risk of HT in SLE.