Vitamin D and rheumatic diseases

Abstract

n INTRODUCTION B esides the well-known effects of vitamin D on the skeleton and on phosphorus and calcium metabolism, unsurprisingly it has also shown to have some extra-skeletal effects and in particular in numerous metabolic, degenerative, inflammatory and autoimmune rheumatic diseases. This is justified by at least four main aspects: 1) the presence of vitamin D receptors in various tissues other than bone cells, such as cartilages, sinoviocytes and muscle cells; 2) the role of vitamin D in the control of the transcription of genes involved in rheumatic diseases; 3) the evidence that vitamin D has multiple endocrine effects not only on calcium homeostasis; 4) the activation of vitamin D not only in the kidney, but also in monocyte-macrophage and lymphocytic cell lines and some epithelial cells.The aim of this review is to summarize the latest evidence concerning the relationship between vitamin D and the most relevant rheumatic diseases, besides skeletal metabolic diseases. n VITAMIN D AND OSTEOPOROSISIt has long been known that vitamin D plays an important role in the regulation of phosphorus, calcium and skeletal metabolism. Hence vitamin D deficiency may cause rickets in children and osteomalacia in adults and can contribute to the pathogenesis of osteoporosis. Over the last year new evidence has emerged of the relationship between vitamin D deficiency and the risk of osteoporosis and fractures (1-4). This is of particular interest, since fractures place a huge burden on healthcare services (5).A recent meta-analysis has demonstrated that patients with the bb-genotype of vitamin D receptor gene BsmI polymorphism SUMMARY Vitamin D has some well-known effects on calcium, phosphate and bone metabolism, but it has recently shown to have many other effects, which may potentially be relevant to patients with extra-skeletal rheumatic diseases. Such effects may be justified by: 1) the presence of the vitamin D receptors also on extra-osseous cells, such as cartilage cells, sinoviocytes, muscle cells; 2) the proven role of vitamin D in the control of the transcription of genes involved in rheumatic diseases; 3) the evidence that vitamin D has multiple endocrine effects not only on calcium homeostasis; 4) the activation of vitamin D not only in the kidneys, but also in monocyte-macrophage and lymphocytic cell lines and in some epithelial cells with additional intracrine and paracrine effects. Vitamin D deficiency has been reported in numerous metabolic, degenerative, inflammatory and autoimmune rheumatic diseases. In some cases this association was also related to the risk of developing a rheumatic disease or the degree of disease activity. However there is no conclusive evidence of the efficacy of a preventive or therapeutic strategy based on vitamin D supplementation in extra-skeletal rheumatic diseases. This review aims to provide an overview of the latest evidence concerning the relationship between vitamin D and the most relevant rheumatic diseases.

Prevalence and incidence of osteoporotic fractures in patients on long-term glucocorticoid treatment for rheumatic diseases: the Glucocorticoid Induced OsTeoporosis TOol (GIOTTO) study

“…In addition, in our patients we found high prevalence of low sunlight exposure and low calcium intake. Vitamin D deficiency is common in patients with rheumatic disease, and associated with disease activity (59)(60)(61). We also evaluated the regular intake of calcium and vitamin D supplements before and during therapy with GCs.…”

Raising awareness on the therapeutic role of cholecalciferol in CKD: a multidisciplinary-based opinion

“…The immunosuppressive effect of 1,25(OH)2D3 is correlated with a decrease in inflammatory cytokines. In fact, for example, in rheumatoid arthritis patients disease activity is inversely correlated to the levels of 25-OH-D [ 131 , 132 ].…”

Liver enzyme abnormalities of inpatients with rheumatic diseases: A 10‐year retrospective study in a Korean medicine hospital

“…Osteoporosis and OA are considered RDs in previous studies (Camafeita, Lamas, Calvo, Lopez, & Fernandez-Gutierrez, 2009;Monjardino, Lucas, & Barros, 2011;Reis & Viana Queiroz, 2014;Toledano et al, 2012). Similar to other RDs, they are commonly characterized by metabolic pathologies such as alteration of osteoblast or vitamin D (Corrado, Maruotti, & Cantatore, 2017;Rossini et al, 2014). Some conventional medicines prescribed for osteoporosis and OA have already been reported to have hepatotoxicity (Papapetrou, 2009;Rostom, Goldkind, & Laine, 2005), but herbal medicines have also been used for the treatment of both diseases (Cameron & Chrubasik, 2014;Liu, Liu, & Xia, 2014).…”