Efficacy of Vitamin D in patients with active rheumatoid arthritis receiving methotrexate therapy

Salesi, Mansour; Farajzadegan, Ziba

doi:10.1007/s00296-011-1944-5

Cited by 63 publications

(53 citation statements)

References 9 publications

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“…Although the studies performed by Salesi and Farajzadegan and Dehghan et al suggested a beneficial effect on disease activity and relapse rate, respectively, neither results reach statistical significance (54, 55). However, Dehghan et al pointed out that for every 10 patients treated with cholecalciferol, relapse would be prevented in one patient.…”

Section: Vitamin D As a Therapeutic Agent In Human Autoimmune Diseasesmentioning

confidence: 86%

“…Vitamin D supplementation guidelines indicate a maximum safe dose of 4,000 IU cholecalciferol/day for healthy adults (226). However, no adverse effects were found with dosages of up to 50,000 IU cholecalciferol weekly for 12 weeks, or 100,000 IU weekly for 1 month followed by 100,000 IU monthly for 5 months (54, 109, 117). Interestingly, the dose-escalation regime used by Burton et al and 20,000 IU weekly by Smolders et al did not elicit hypercalcemia despite reaching a serum 25(OH)D 3 level of 400 and 380 nmol/L, respectively (49, 117).…”

Section: Future Directionsmentioning

confidence: 92%

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Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential

et al. 2017

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Over the last three decades, it has become clear that the role of vitamin D goes beyond the regulation of calcium homeostasis and bone health. An important extraskeletal effect of vitamin D is the modulation of the immune system. In the context of autoimmune diseases, this is illustrated by correlations of vitamin D status and genetic polymorphisms in the vitamin D receptor with the incidence and severity of the disease. These correlations warrant investigation into the potential use of vitamin D in the treatment of patients with autoimmune diseases. In recent years, several clinical trials have been performed to investigate the therapeutic value of vitamin D in multiple sclerosis, rheumatoid arthritis, Crohn’s disease, type I diabetes, and systemic lupus erythematosus. Additionally, a second angle of investigation has focused on unraveling the molecular pathways used by vitamin D in order to find new potential therapeutic targets. This review will not only provide an overview of the clinical trials that have been performed but also discuss the current knowledge about the molecular mechanisms underlying the immunomodulatory effects of vitamin D and how these advances can be used in the treatment of autoimmune diseases.

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Section: Vitamin D As a Therapeutic Agent In Human Autoimmune Diseasesmentioning

confidence: 86%

Section: Future Directionsmentioning

confidence: 92%

Vitamin D in Autoimmunity: Molecular Mechanisms and Therapeutic Potential

et al. 2017

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“…The Iranian study found no effect on Disease Activity Score or any other clinical outcome. 62 The Indian study found no difference in time to pain relief (their primary outcome), but reported that patients in the vitamin D arm had greater improvement in pain at 3 months on a visual analogue scale (VAS; median 50 vs. 30 % control group, p = 0.006). 63 The authors mistakenly tried to convert this continuous score difference to a number needed to treat.…”

Section: Belief 5: Vitamin D Can Prevent or Treat Rheumatoid Arthritimentioning

confidence: 99%

“…When Treatment. We identified three small RCTs [62][63][64] in patients with RA (Table 5), all with substantial issues with quality. One study 64 from Sweden, published over 40 years ago, reported that 31 % more patients on high-dose vitamin D (100,000 IU/ day) had clinical improvements at 1 year.…”

Section: Belief 5: Vitamin D Can Prevent or Treat Rheumatoid Arthritimentioning

confidence: 99%

Vitamin D: A Narrative Review Examining the Evidence for Ten Beliefs

Allan

Cranston²,

Lindblad

et al. 2016

J GEN INTERN MED

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Over the past decade, a large body of observational evidence has suggested an association between lower vitamin D status (25-hydroxyvitamin D) and multiple acute and chronic disorders, including cancer, multiple sclerosis, depression and respiratory tract infections. This evidence has fostered the hypothesis that increasing vitamin D intake may treat and prevent such disorders. Our objective was to perform a critical analysis of the highestlevel evidence for ten common beliefs regarding vitamin D for the prevention of falls, fractures and respiratory tract infections, the reduction of cancer incidence/mortality and overall mortality, and the prevention or treatment of depression/mental well-being, rheumatoid arthritis and multiple sclerosis, as well as maximum dosing and regular testing. We searched the Cochrane Database of Systematic Reviews and PubMed (up to August 2014) for randomized controlled trials and systematic reviews/ meta-analyses based on those studies. All searches were performed, all evidence reviewed and each section written by at least two authors. The evidence shows that vitamin D supplementation provides some benefit in fracture prevention (likely ∼10-15 % relative reduction), particularly at a dose ≥800 IU and with calcium; a likely benefit in the rate of falls, though it is less clear whether the number of fallers changes; and a possible small (∼5 %) relative reduction in mortality. Evidence does not support the use of vitamin D supplementation for the prevention of cancer, respiratory infections or rheumatoid arthritis. Similarly, evidence does not support vitamin D supplementation for the treatment of multiple sclerosis and rheumatoid arthritis or for improving depression/mental well-being. Regular testing of 25-hydroxyvitamin D is generally not required, and mega-doses (≥300,000 IU) appear to increase harms. Much of the evidence is at high risk of bias, with multiple flaws, including analyses of secondary endpoints, small and underpowered studies, inconsistent results and numerous other issues. Therefore, enthusiasm for a vitamin D panacea should be tempered.

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“…A double-blind, placebo-controlled trial of 117 subjects [14] detected no change in RA following 12 weeks of vitamin D, but baseline repletion (mean 25(OH)D 43 ng/mL) might explain the null effect. Observationally, among 499 RA golimumab clinical trial subjects [15], baseline vitamin D status was unrelated to DAS-28, erosions, C-reactive protein or therapeutic response.…”

Section: Discussionmentioning

confidence: 99%