Title: Normal Vs Low Serum Level Vitamin D in Patient with Symptomatic Early RA Disease Activity
Authors: Sami Abdulhakim, Salama Saad Abdullatif, Gamal Abobar, Maay Weza
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.128
Abstract
The aim of this study to show the relation of low vs normal serum vitamin D 25(OH)D (vit D) level in the patient with early onset RA to disease activity.
METHODS: 92 RA Patients (72 female and 20 male) with recent-onset RA were assessed clinically and radiographically of both hand x-ray and MSUS assessment, laboratory assessment (RF, anti-CCP, CBC, ESR, and chemistry), disease activity measurement (disease activity HAQ, VAS and DAS-28 score), all data were obtained at the beginning of first three months the disease. Patients are classified into two groups according to the level of vitamin D (normal or low). All cases of hyperparathyroidism, hypothyroidism and the patients who are already received vitamin D or biological therapy are excluded in the study.
RESULTS: 92 RA patients (72 females, 20 males) with early onset RA disease less than 6 six months duration. Healthy group age was 38.05±3.49 with normal vitamin D serum level 32.13±13.07. Total patient showed mild decrease in Vit. D than normal value, but there is highly significant differences between DAS-28, HAQ, VAS, MSUS assessment in patient low vs normal Vit. D and inverse relation with disease activity and a significant correlation with disease activity HAQ, and VAS score p<0.05.
CONCLUSIONS: There is statistical significant relation with disease activity assessment difference between low vs normal 25(OH)D serum levels in RA early disease activity, So large number of epidemiological studies needed for optimal 25(OH)D concentrations with serial assessment of disease activity in RA patients.
KEYWORD: RA, Vit D low vs normal value, MSUS.
References
1. Andjelkovic Z, Vojinovic J, Pejnovic N, Popovic M, Dujic A, Mitrovic D, Pavlica L, Stefanovic D. Disease modifying and immunomodulatory effects of high dose 1 alpha (OH) D3 in rheumatoid arthritis patients. Clin Exp Rheumatol. 1999 Jul-Aug;17(4):453-6.
2. Attar SM.Vitamin D deficiency in rheumatoid arthritis. Prevalence and association with disease activity in Western Saudi Arabia. Saudi Med J. 2012 May;33(5):520-5.
3. Ifigenia Kostoglou-A, Panagiotis A, Aikaterini L, Ioannis R, and Christodoulos A: Vitamin D and rheumatoid arthritis Ther Adv Endocrinol Metab. 2012 December; 3(6): 181–187.
4. Baykal T, Senel K, Alp F, Erdal A, Ugur M.Is there an association between serum 25-hydroxyvitamin D concentrations and disease activity in rheumatoid arthritis? Bratisl Lek Listy. 2012;113(10):610-1.
5. Craig S., Yu F., Curtis J., Alarcón G., Conn D., Jonas B., et al. (2010) Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol 37: 275–281. [PMC free article]
6. Cutolo M, Plebani M, Shoenfeld Y, Adorini L, Tincani A. Vitamin D endocrine system and the immune response in rheumatic diseases. Vitam Horm. 2011;86:327-51.
7. Cutolo M., Otsa K., Laas K., Yprus M., Lehtme R., Secchi M., et al. (2006) Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol 24: 702–704.
8. Ellegaard K, Torp-Pedersen S, Terslev L, Danneskiold-Samsoe B, Henriksen M, Bliddal H. Ultrasound Colour Doppler measurements in a single joint as measure of disease activity in patients with rheumatoid arthritis assessment of current validity. Rheumatology (Oxford) 2009; 48: 254-257.
9. Hirani V. (2012) Vitamin D status and pain: analysis from the Health Survey for England among English adults aged 65 years and over. Br J Nutr 107: 1080–1084.
10. Kim T., Choi S., Lee Y., Song G., Ji J. (2012) Combined therapeutic application of mTOR inhibitor and vitamin D(3) for inflammatory bone destruction of rheumatoid arthritis. Med Hypotheses 79: 757–760.
11. Kostoglou-Athanassiou I, Athanassiou P, Lyraki A, Raftakis I, Antoniadis C.Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab. 2012 Dec;3(6):181-7.
12. Kroot EJ, de Jong BA, van Leeuwen MA, Swinkels H, van den Hoogen FH, van’t Hof M, et al. The prognostic value of anti-cyclic citrullinated peptide antibody in patients with recentonset RA. Arthritis Rheum 2000;43:1831–5. 24.
13. Laragione T, Shah A, Gulko PS. The vitamin D receptor regulates rheumatoid arthritis synovial fibroblast invasion and morphology. Mol Med. 2012 Mar 27;18(1):194-200.
14. Merlin LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004;50:72–7.
15. Naredo E, Rodriguez M, Campos C, et al. Validity, reproducibility and responsive-eness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008; 59:515-522.
16. Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D: Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum 2007, 56:2143-2149
17. Sen D, Ranganathan P.Vitamin D in rheumatoid arthritis: panacea or placebo? Discov Med. 2012 Nov;14(78):311-9.
18. Souberbielle JC, Body JJ, Lappe JM, Plebani M, Shoenfeld Y, Wang TJ, et al. Vitamin D and musculoskeletal health, cardiovascular disease, autoimmunity, and cancer: Recommendations for clinical practice. Autoimmun Rev. 2010; 9:709–715
19. Weiss S. (2011) Bacterial components plus vitamin D: the ultimate solution to the asthma (autoimmune disease) epidemic? J Allergy Clin Immunol 127: 1128–1130. [PMC free article].
20. Welsh P., Peters M., Mc Innes I., Lems W., Lips P., McKellar G., et al. (2011) Vitamin D deficiency is common in patients with RA and linked to disease activity, but circulating levels are unaffected by TNFα blockade: results from a prospective cohort study. Ann Rheum Dis 70: 1165–1167.
Sami Abdulhakim
Rheumatol and Rehabilitation, Faculty of Medicine
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.