Plasma homocysteine level in patients with Behçet's disease

Dear Editor, We have read with interest the article ‘The relationship between plasma homocysteine (Hcy) level and HLAB51 in patients with Behc et’s disease: a casecontrol study’ written by Shadmanfar et al. The authors did not find any possible relationship between plasma homocysteine levels and HLA-B51. They concluded that no relationship between plasma homocysteine levels and HLA-B51 existed in this study, either in Behc et’s disease (BD) or in the control group. Behc et’s disease is a chronic relapsing systemic vasculitis that can involve almost every organ and system in the body with extremely different diverse manifestations. Inflammatory markers such as arterial stiffness and endocan seem to be associated with disease activity and systemic involvement in BD. The significant increase in inflammatory indicators may arise from the severity of inflammation in the tissue or organ involved. Hcy levels may increase the susceptibility to vascular complications in patients with BD. Plasma Hcy levels were elevated in patients with BD and correlated well with the degree of endothelial damage. It was concluded that hyperhomocysteinemia may be an independent risk factor for venous thrombosis. Several dietary and lifestyle factors, genetic defects, nutritional deficiencies, and other etiologies can cause elevations in Hcy. Several drugs and toxins increase plasma Hcy concentrations. Hcy levels may be affected by many conditions such as inflammatory disease, coronary artery disease and cardiovascular risk factors. For this reason, it would be useful if the authors had mentioned these factors. Male sex, family history, a younger age of onset, HLAB51 positivity and positive pathergy test are related to more vascular involvement in BD. So, in the present study, the authors did not evaluate the relationship between Hcy levels and age of onset, family history, positive pathergy test or other systemic manifestations. If these assessments were made, they would have identified risk factors of vascular involvement. As a conclusion, there is no relationship between plasma Hcy levels and HLA-B51 in the authors’ study. However, Hcy levels may be associated with some conditions and further studies should evaluate these conditions.