Serum 25-hydroxyvitamin D and biochemical markers of bone metabolism in patients with juvenile idiopathic arthritis

Abstract

Our objective was to evaluate the concentrations of serum 25-hydroxyvitamin D [25(OH)D], serum calcium, serum phosphorus, alkaline phosphatase, and parathormone (PTH) in patients with polyarticular juvenile idiopathic arthritis (JIA) and to associate them with disease duration and activity, bone mineral density and use of medications. In a cross-sectional and controlled study, 30 patients with polyarticular JIA were evaluated and compared to 30 healthy individuals matched for age and gender. Clinical status, anthropometry, laboratory markers in both patients and controls, and bone mineral density, only in the patients, were measured. Of the 30 patients included in the study, 23 (76.7%) were female and 16 (53.3%) non-Caucasian; mean age was 14 years (range = 4 to 20 years). Mean disease duration was 5 years (range = 1 to 12 years). The mean concentrations of serum albumin-corrected calcium (9.04 ± 0.41 mg/dL) and alkaline phosphatase (153.3 ± 100.1 IU) were significantly lower in patients with JIA than in controls (P < 0.0001 and P = 0.001, respectively). No differences in 25(OH)D, PTH or serum phosphorus were observed between JIA and control subjects. Regarding 25(OH)D concentration, 8 patients (26.7%) and 5 controls (16.7%) had 25(OH)D concentrations compatible with deficiency (lower than 20 ng/mL) and 14 patients (46.7%) and 18 controls (60%) had concentrations compatible with insufficiency (20-32 ng/mL). These values were not associated with disease activity, use of medications or bone mineral density. We observed a high frequency of 25(OH)D insufficiency and deficiency in the study sample. The compromised bone metabolism emphasizes the importance of follow-up of JIA patients.

Vitamin D levels in juvenile idiopathic arthritis from an equatorial region

“…It has to be pointed out that all those studies were done in high latitudes, including those on Florence and Rabat, meaning 42° and 32°N [15,27], respectively, as compared to the present study. Perhaps more striking, with regard to the importance of geographical variation, 25OHD levels in children from the state of São Paulo, Brazil (23°S), were reported as 25.7 ± 8.65 ng/mL [28] that are also lower to those found in our study, focusing on people living in a 4°S region of Brazil.…”

Vitamin D and juvenile idiopathic arthritis

“…No correlation between disease activity, type of JIA or metabolites of vitamin D. Control n = 28 Age, gender matched, hospitalized children 43.4 ± 40.7 nmol/L. Sao Paulo, Brazil Munekata et al 2013 23°S [ 25 ] JIA- polyarticular n = 30 (23F) 14 (4–20) 64.1 ± 21.6 High frequency of 25(OH)D deficiency in both control and JIA groups; no difference between the two. No association of 25(OH)D with disease activity.…”

“…Of the 38 studies reviewed, six (15.8%) had mean 25(OH)D concentrations above 75 nmol/L [ 28 , 42 , 44 , 45 , 53 , 54 ]. Seventeen studies (44.7%) had mean 25(OH)D concentrations between 50 and 75 nmol/L [ 22 , 23 , 25 , 27 , 30 , 33 , 34 , 36 , 37 , 39 , 40 , 46 – 48 , 55 , 59 ] and 15 (39.5%) had values below 50 nmol/L [ 21 , 24 , 26 , 29 , 31 , 32 , 35 , 38 , 41 , 43 , 49 – 51 , 57 , 60 ]. Of those 15 studies, 10 reported the mean 25(OH)D value, the median value reported for one study and a range or cutoff was provided for four studies).…”

“…Of those 15 studies, 10 reported the mean 25(OH)D value, the median value reported for one study and a range or cutoff was provided for four studies). Of the 14 studies (36.8%) that published mean 25(OH)D status of healthy control groups, nine (64.3%) had mean control values significantly greater than the population with childhood arthritis [ 21 – 23 , 31 , 41 , 43 , 49 , 50 ], three (21.4%) had concentrations that were statistically similar [ 25 , 39 , 60 ], and two studies (14.3%) had mean 25(OH)D values significantly below the juvenile arthritis comparison groups [ 47 , 48 ]. One study compared 25(OH)D concentrations in children with JIA to hospitalized children and found no statistically significant difference between the two groups [ 24 ].…”

Homocysteine, Folic Acid, Vitamin B6, Vitamin B12, and Biochemical Parameters of Bone Metabolism in Female Patients with Systemic Lupus Erythematosus

“…Study of Raghu Nadhanan et al found that low dose of methotrexate can increase the risk of osteopenia [30]. But, other immunosuppressants such as Azathioprin, Chloroquine, Cyclophosphamide and Mycophenolat mofetil have no interference in bone mass density [31][32][33].…”