Vitamin D and early rheumatoid arthritis

Abstract

Background: Previous studies have linked rheumatoid arthritis (RA) risk and disease activity with vitamin D-deficiency (low serum 25-hydroxyvitamin D (25OHD)), but a causal role for vitamin D in RA is still unclear, with conflicting results from many previous studies, partly due to heterogeneity in study design and patient populations. In this study we aimed to (1) analyse serum 25OHD in early inflammatory arthritis, (2) compare 25OHD with disease activity and fatigue in early RA and (3) determine whether low 25OHD is associated with progression to RA. Methods: An analysis of 790 patients recruited to the Birmingham Early Inflammatory Arthritis Cohort and followed longitudinally to determine clinical outcomes. The following were recorded at baseline: demographic data, duration of symptoms, duration of early morning stiffness (EMS), tender and swollen joint counts, Visual Analogue Scale (VAS) pain/ fatigue/EMS, PHQ-9, HAQ and FACIT-Fatigue scores, DAS28-ESR, DAS28-CRP, CRP, ESR, anti-CCP antibody status, rheumatoid factor status, and serum 25OHD (ng/ml). Diagnosis was recorded at 0 and 12 months onwards as either RA, Undifferentiated Inflammatory Arthritis (UIA; synovitis not meeting other classification/diagnostic criteria), Clinically Suspect Arthralgia (CSA; arthralgia of an inflammatory type without synovitis), or Other. Results: Baseline demographic data were similar between all groups, with median symptom duration of 16.8-34.0 days. Baseline 25OHD was not significantly different between groups [median, interquartile range (IQR): RA 46.7, 30.0-73.3; UIA 51.4, 30.0-72.3; CSA 47.7, 30.3-73.0; Other 39.9, 28.6-62.2]. In RA (n = 335), there were no significant differences between 25OHD and measures of disease activity or fatigue. No association between 25OHD and progression from UIA or CSA to RA was observed. Conclusions: There was no clear association between serum 25OHD and baseline diagnosis, RA disease activity, or progression from UIA or CSA to RA. Future studies of other vitamin D metabolites may better define the complex role of vitamin D in RA.

A Roadmap for Investigating Preclinical Autoimmunity Using Patient-Oriented and Epidemiologic Study Designs: Example of Rheumatoid Arthritis

“…Previously completed studies suggesting a correlation between early RA and Vitamin D deficiency were reexamined using data from the Birmingham Early Arthritis Clinic Cohort (BEACON) ( 152 ). Using samples from 790 patients enrolled in the cohort, the authors, including Karim Raza and Andrew Filer, the primary investigators of the BEACON cohort, found no clear relationships between early RA and 25OHD, or low serum 25-ydroxyvitamin D) ( 152 ). By using synovial fluid, Raza and his team recognized that the make-up of joint fluid in early RA patients was distinct from that of other inflammatory diseases ( 153 ).…”

Seasonal and Treatment-Related Variation in 25-Hydroxy Vitamin D Concentration in Patients with Rheumatoid Arthritis

“…It may result in joint destruction, loss of function, and disability and can negatively influence cardiovascular health [10]. It has recently been found that 25-OH-D level is associated with disease progression and neuropathic pain in RA patients [5,11,12].…”

The Association between Serum Vitamin D Concentration and Colon Polyp: A Cross-Sectional Study Using Health Care Screening Database in a Tertiary Hospital in Korea

“…1) Several recent studies have shown that vitamin D deficiency is associated with some types of cancers [2][3][4] as well as chronic diseases such as hypertension, 5) diabetes, 6) cardiovascular diseases, 7) and autoimmune diseases. 8) In meta-analysis of retrospective studies, higher serum vitamin D levels were associated with lower risk of colorectal and breast cancer. 3,4) A meta-analysis of nine prospective cohort studies also showed that increase in vitamin D intake and serum 25-hydroxycholecalciferol (25(OH)D) levels reduced the risk of colorectal cancer incidence.…”