Vitamin D Deficiency in Axial Spondyloarthritis is Associated With Higher Disease Activity

Abstract

Objectives: This study aims to assess whether vitamin D deficiency is associated with increased disease activity and functional impairment in axial spondyloarthritis (axSpA), with control for its seasonal variation. Patients and methods: Serum 25-hydroxyvitamin D [25(OH)D] levels were measured in 235 consecutive axSpA patients (176 males, 59 females; mean age 46.3 years; range 18 to 85 years) attending a specialist spondyloarthritis service in the United Kingdom. Disease activity and functional status were assessed using Bath Ankylosing Spondylitis indices, C-reactive protein, and erythrocyte sedimentation rates. Vitamin D deficiency was defined as 25(OH)D <30 nmol/L. Associations between vitamin D deficiency and: (i) disease activity (Bath Ankylosing Spondylitis Disease Activity Index), (ii) spinal pain, (iii) functional impairment (Bath Ankylosing Spondylitis Functional Index), and (iv) inflammatory markers were explored using multivariable logistic regression models (adjusted for age, sex, vitamin D supplementation, and seasonal variation). Results: Median symptom duration was 17 years (inter-quartile range 8.5 to 28.6 years). Median 25(OH)D was 54.5 nmol/L (inter-quartile range 34 to 77 nmol/L) and 52 patients (22%) were deficient for vitamin D. Increasing Bath Ankylosing Spondylitis Disease Activity Index (adjusted odds ratio 1.23; 95% confidence interval 1.06-1.41), spinal pain visual analog scale (adjusted odds ratio 1.21; 95% confidence interval 1.07-1.38), and C-reactive protein (adjusted odds ratio 1.02; 95% confidence interval 1.01-1.04) were each significantly associated with 25(OH)D deficiency. Conclusion:This cross-sectional study demonstrated associations between vitamin D deficiency and both higher disease activity and functional impairment in axSpA. Whilst this may reflect reduced ultra-violet exposure in functionally impaired patients, it supports the hypothesis that vitamin D may have an immunomodulatory role. Interventional studies are needed to evaluate a potential causal relationship, as optimizing vitamin D may be a cost-effective adjunctive intervention to modify disease activity in axSpA.

Vitamin D serum concentration is not related to the activity of spondyloarthritis – preliminary study

“…Our results are contrary to data from other studies that reported a significant association between vitamin D and activity of SpA as well as structural damage [1, 3, 4]. However, differences in the study population and in the definition of vitamin deficiency do not allow direct comparison of these results.…”

“…Deficiency of vitamin D is frequent in patients with spondyloarthritis (SpA) [1, 2] and some data suggest its association with increased disease activity and structural damage [3, 4]. Apart from the endocrine role in bone metabolism by maintaining mineral homeostasis, vitamin D 3 can modulate both innate and adaptive immune responses.…”

“…Several studies have shown dissimilar results for the relationship between serum 25(OH)D concentration and activity of SpA. Zhao et al [3] found significantly higher Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), spinal pain visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in axial spondyloarthritis (axSpA) patients deficient in vitamin 25(OH)D (< 30 nmol/l) as compared to non-deficient patients. Also Hmamouchi et al [4] reported higher BASDAI, Ankylosing Spondylitis Disease Activity Score (ASDAS) and radiological sacroiliitis score in early axSpA deficient for vitamin 25(OH)D (< 50 nmol/l).…”

Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases

“…The current evidences deriving from systematic reviews and meta-analysis suggest that AS patients harbor lower vitamin D values than controls [71,72]. However, whether an association links vitamin D status to disease activity is debated, with some papers demonstrating an inverse association between 25(OH)D3 and disease activity [73,74] and others refusing this finding [75,76]. Currently, there are no trials investigating the effect of vitamin D supplementation on disease activity.…”

Role of vitamin D in autoimmune rheumatic diseases- hype or real?

“…46 But a crosssectional study by Zhao et al, which demonstrated an association between vitamin D deficiency and both higher disease activity and functional impairment in axial SpA, supports the hypothesis that vitamin D has an immunomodulatory role. 47 A study conducted on Chinese patients showed a significantly lower vitamin D levels in Chinese axial SpA patients as compared to the control group.…”