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Electronic databases were searched from inception to 15 July 2023 for relevant articles. We assessed the risk of bias using the JBI checklist and the certainty of evidence using GRADE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In 28 eligible studies, compared to controls, RA patients had significantly higher concentrations of homocysteine (standardized mean difference, SMD\u2009=\u20090.74, 95% CI 0.54\u20130.93, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; low certainty of evidence) and methionine (SMD\u2009=\u20091.00, 95% CI 0.57\u20131.44, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; low certainty) and lower concentrations of vitamin B<jats:sub>6<\/jats:sub> (SMD\u2009=\u2009\u22126.62, 95% CI \u22129.65 to \u22123.60, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001; low certainty). By contrast, there were non\u2010significant between\u2010group differences in vitamin B<jats:sub>12<\/jats:sub> and folic acid. In meta\u2010regression and subgroup analysis, there were no associations between the effect size and several study and patient characteristics except for homocysteine (year of publication, C\u2010reactive protein, triglycerides, and analytical method) and folic acid (biological matrix).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The results of our study suggest that homocysteine, methionine, and vitamin B<jats:sub>6<\/jats:sub> are promising biomarkers to assess nitric oxide dysregulation and oxidative stress in RA. (PROSPERO registration number: CRD42023461081).<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.14158","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T09:40:03Z","timestamp":1705052403000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Transsulfuration and folate pathways in rheumatoid arthritis: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8699-1412","authenticated-orcid":false,"given":"Arduino A.","family":"Mangoni","sequence":"first","affiliation":[{"name":"Discipline of Clinical Pharmacology, College of Medicine and Public Health Flinders University  Adelaide South Australia Australia"},{"name":"Department of Clinical Pharmacology, Flinders Medical Centre Southern Adelaide Local Health Network  Adelaide South Australia 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