Deformation analysis by speckle-tracking echocardiography is a valuable tool to detect early development of myocardial dysfunction despite normal ejection fraction in RA.

The vitamin D metabolite 1,25(OH) D was inversely associated with disease activity and positively associated with ACPA in treatment naïve and inflammatory active early RA. The results indicate that in RA, both the degree of inflammatory activity, and the diagnostic sensitivity and specificity might affect-or might be affected by the level of vitamin 1,25(OH) D.

the study evaluates associations between serum vitamin D metabolites at diagnosis and one-year remission, in early diagnosed rheumatoid arthritis(RA). The CIMESTRA-cohort comprised 160 newly diagnosed RA patients, treated aiming at remission. Vitamin D supplementation was recommended according to national guidelines. D total (25OHD 2 + 25OHD 3) was dichotomized at 50 nmol/L, 1,25(OH) 2 D was categorized in tertiles. Primary outcome was remission(DAS28-CRP ≤ 2.6) after one year. Associations were evaluated using logistic regression, further adjusted for pre-specified potential confounders: Age, sex, symptom-duration before diagnosis, DAS28-CRP and season of diagnosis. Results are presented as Odds Ratios(OR) with 95% Confidence Intervals(95%CIs). In univariate analyses, neither D total nor 1,25(OH) 2 D were associated with remission. In adjusted analyses, low D total was associated with higher odds for remission; OR 2.6, 95%CI (1.1; 5.9) p = 0.03, with season impacting results the most. one-year remission was lower in patients with diagnosis established at winter. in conclusion, low D total at diagnosis was associated with increased probability of achieving one-year remission in early RA when adjusting for covariates. Diagnosis in winter was associated with lower odds for one-year remission. Results suggest that season act as a contextual factor potentially confounding associations between vitamin D and RA disease-course. The finding of low D total being associated with higher one-year remission remains speculative. Mounting evidence suggests vitamin D as an important immune-modulator 1,2. Circulating 25OHD 3 is produced in the skin upon sun-exposure, dependent on e.g. season and latitude 3 , and circannual variation in 25OHD is well-known in Northern latitude 4. 25OHD serves as substrate for conversion into the active metabolite; 1,25(OH) 2 D, both in the kidneys 3 and locally in macrophages, dendritic cells and lymphocytes 5. Immunomodulation by sufficient levels of 1,25(OH) 2 D includes altered differentiation and maturation of dendritic cells, macrophages and lymphocytes 5 , and inhibition of pro-inflammatory cytokines 6. The main-effect of vitamin D on the immune system is to balance the immune-response away from the self-aggressive Th1/ Th17-response and towards the tolerogenic Th2/Th-regulatory response 7,8 .