Serum vitamin D status inversely associates with a prevalence of severe sarcopenia among female patients with rheumatoid arthritis

Abstract

Sarcopenia is an age-related disease with an increased risk of mortality. It is emerging that low serum 25-hydroxyvitamin D [25(OH)D] affects the sarcopenic state in general, but in rheumatoid arthritis (RA), these associations are not understood although the prevalence of vitamin D insufficiency is high in RA. We conducted a cross-sectional study of older female outpatients from our cohort (KURAMA) database. We measured skeletal muscle mass, handgrip strength, and gait-speed to diagnose severe sarcopenia. The serum 25(OH)D concentration was measured using electrochemiluminescence immunoassay. A total of 156 female patients with RA (sarcopenia:44.9%, severe sarcopenia: 29.5%, and without sarcopenia: 25.6%) were enrolled. Classification of vitamin D status at a cutoff point of median 25(OH)D concentration revealed that low 25(OH)D status was associated with a high prevalence of severe sarcopenia and with low measured values of muscle mass, handgrip, and gait speed. Furthermore, multivariable logistic regression analysis identified that low 25(OH)D status was associated with a high prevalence of severe sarcopenia (OR 6.00; 95% CI 1.99–18.08).The same association was observed when the cut-off value was set at 20 ng/ml. In components of sarcopenia, both low physical performance and muscle mass were associated with low 25(OH)D status. In conclusion, vitamin D status was inversely associated with severe sarcopenia, low physical performance, and low skeletal muscle mass. Modification of vitamin D status including vitamin D supplementation should be investigated as a therapeutic strategy for sarcopenic patients with RA.

From the Bench to the Bedside: Branched Amino Acid and Micronutrient Strategies to Improve Mitochondrial Dysfunction Leading to Sarcopenia

“…In line, in animal models, diet-induced vitamin D deficiency leads to the manifestation of sarcopenia symptoms in skeletal muscles, including muscle weakness, decreased muscle force and physical performance, and reduced mitochondrial activity [ 129 , 135 , 136 , 137 , 138 ]. Moreover, reduced vitamin D levels have been associated with decreased muscular mass and strength in different human cohorts [ 139 , 140 , 141 , 142 ]. Despite these association studies and the biological plausibility of the link between vitamin D and muscle health, intervention studies are conflicting.…”

Role of Myostatin in Rheumatoid Arthritis: A Review of the Clinical Impact

“…It has recently been found that patients with RA have lower levels of vitamin D than patients without RA [ 106 ]. Additionally, it has been reported that, in patients with RA, low levels of vitamin D are related to severe sarcopenia and poor physical performance [ 107 ]. The reason this association exists is because vitamin D participates in the regulation of oxidative stress and calcium homeostasis, the suppression of cytokines and macrophages, and the promotion of the differentiation of regulatory T cells [ 107 ].…”

“…Additionally, it has been reported that, in patients with RA, low levels of vitamin D are related to severe sarcopenia and poor physical performance [ 107 ]. The reason this association exists is because vitamin D participates in the regulation of oxidative stress and calcium homeostasis, the suppression of cytokines and macrophages, and the promotion of the differentiation of regulatory T cells [ 107 ]. On the other hand, in a study conducted in mice with induced muscular dystrophy, the inhibition of myostatin through the expression of the follistatin transgene resulted in early improvements in histopathology, but, in the long term, muscle degeneration increased [ 108 ].…”

South Asian Working Action Group on SARCOpenia (SWAG-SARCO) – A consensus document

“…The secondary causes of sarcopenia result from comorbidities that affect the patient's osteo-arthro-muscular triad or the bio-psycho-social triad in some way, leading to poor quality of life (QoL). There is abundant literature to support the osteo-arthro-muscular triad [ [23] , [24] , [25] , [26] , [27] , [28] ] or the bio-psycho-social triad [ [29] , [30] , [31] , [32] ] comorbidities as a cause of secondary sarcopenia. Corresponding literature from South Asia includes an article from Pakistan, that mentions that major depression is associated with low QoL and leads to sarcopenia with loss of muscle mass and function [ 33 ].…”