Are Systematic Screening for Vitamin D Deficiency and Vitamin D Supplementation Currently Feasible for Ankylosing Spondylitis Patients?

Abstract

Beyond its role in calcium and phosphorus metabolism for healthy bone mineralization, there is increasing awareness for vitamin D contribution in modulation of immune reactions. Given that ankylosing spondylitis (AS) is a chronic inflammatory disease involving excess immune/inflammatory activity and posing great therapeutic challenges, it is conceivable to claim that vitamin D treatment may be a safe and effective treatment to influence or modify the primary disease and its related comorbidities. Nevertheless, consistent body of research supporting this hypothesis is still lacking. In this paper, we examine whether systematic screening and treatment for vitamin D deficiency are feasible at present. We will review the immunomodulatory role of vitamin D and its contribution in initiation and progression of AS, as well as how they would determine the occurrence of comorbid conditions. Our conclusion is that despite the overwhelmed interest about vitamin D treatment in AS patients, systematic screening and treatment for vitamin D deficiency of all AS patients are not feasible as yet. This stresses the need for further extensive well-designed research to prove vitamin D efficacy in AS beyond bone protection. And if utility is proven, personalized treatment regimes, duration of treatment, and threshold values for vitamin D should be provided.

Calcium physiology, metabolism and supplementation: a glance at patients with ankylosing spondylitis

“…Due to its antiinflammatory role, the use of vita min D in deficient AS subjects should be advisable along with calcium supplementation [64]. The use of vitamin D derivatives in AS patients may have several immunomod ulatory effects, including the inhibition of IL17 produc ing cells and the activation of IL22 secreting cells [65].…”

Nutritional aspects and vitamin D supplementation in ankylosing spondylitis

“…Kalogeropoulou To reduce this burden in terms of expenditure and quality of life, particular attention should be devoted to all intervention measures and especially to the non-pharmaceutical. There is evidence, supporting that lifestyle, especially diet and supplementation of vitamin D, has a significant role in disease progression and improving the well-being of these patients [12][13][14] . Furthermore, significant evidence indicates that nutritional factors, such as high starch consumption and other factors, such as the blood phospholipids that are rich in arachidonic acid, fatty acids abnormality, and low levels of vitamin D, are related to the development of AS and psoriatic arthritis [14][15][16][17] .…”

“…There is evidence, supporting that lifestyle, especially diet and supplementation of vitamin D, has a significant role in disease progression and improving the well-being of these patients [12][13][14] . Furthermore, significant evidence indicates that nutritional factors, such as high starch consumption and other factors, such as the blood phospholipids that are rich in arachidonic acid, fatty acids abnormality, and low levels of vitamin D, are related to the development of AS and psoriatic arthritis [14][15][16][17] . The purpose of this review is primarily to investigate the relationship between diet and disease progression as well as to identify a nutritional care process based on clinical practice guidelines that could improve the well-being of people with AS.…”

“…Additionally, can alter both B and T cell immune actions and may reduce the proinflammatory effects of anti-Klebsiella antibodies in AS. In general, 1,25(OH) 2 D has the ability to alter immune cells' production of antiinflammatory/proinflammatory cytokines and impair their interactions in this way, modulate immune reactions 14 .…”

“…As mention patients with AS, frequently present increased rate of osteoporosis, poor quality of bones and vertebral fractures. Therefore, a screening of osteoporosis within a period of 10 years since the diagnosis is suggested and an assessment of the identified risk factors as well as the duration and activity of AS should also be considered 14,80 .…”