Vitamin D deficiency in chronic inflammatory rheumatic diseases: results of the cardiovascular in rheumatology [CARMA] study

Abstract

IntroductionThe aim was to study the association between 25-hydroxyvitamin D (25(OH)D) levels and the clinical characteristics of patients with chronic inflammatory rheumatic diseases (CIRD).MethodsWe studied a cross-section from the baseline visit of the CARMA project (CARdiovascular in rheuMAtology), a 10-year prospective study evaluating the risk of cardiovascular events in rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients, and non-CIRD patients who attended rheumatology outpatient clinics from 67 hospitals in Spain. Non-CIRD group was frequency matched by age with the joint distribution of the three CIRD groups included in the study. 25(OH)D deficiency was defined if 25(OH)D vitamin levels were < 20 ng/ml.Results2.234 patients (775 RA, 738 AS and 721 PsA) and 677 non-CIRD subjects were assessed. The median (p25-p75) 25(OH)D levels were: 20.4 (14.4-29.2) ng/ml in RA, 20.9 (13.1-29.0) in AS, 20.0 (14.0-28.8) in PsA, and 24.8 (18.4-32.6) ng/ml in non-CIRD patients. We detected 25(OH)D deficiency in 40.5 % RA, 39.7 % AS, 40.9 % PsA and 26.7 % non-CIRD controls (p < 0.001). A statistically significant positive association between RA and 25(OH)D deficiency was found (adjusted (adj.) OR = 1.46; 95 % CI = 1.09-1.96); p = 0.012. This positive association did not reach statistical significance for AS (adj. OR 1.23; 95 % CI = 0.85-1.80) and PsA (adj. OR 1.32; 95 % CI = 0.94-1.84). When the parameters of disease activity, severity or functional impairment were assessed, a marginally significant association between 25(OH)D deficiency and ACPA positivity in RA patients (adj. OR = 1.45; 95 % CI = 0.99-2.12; p = 0.056), and between 25(OH)D deficiency and BASFI in AS patients (adj. OR = 1.08; 95 % CI = 0.99-1.17); p = 0.07) was also found.ConclusionsPatients with RA show an increased risk of having 25(OH)D deficiency compared to non-CIRD controls.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-015-0704-4) contains supplementary material, which is available to authorized users.

Vitamin D in Rheumatic Diseases: Interpretation and Significance

“…Avoidance of sunshine, photoprotection, renal insufficiency, and the use of medications which alter the metabolism of vitamin D or downregulate the functions of the vitamin D receptor like glucocorticoids, anticonvulsants, antimalarials, and the calcineurin inhibitors are some of the causes of VDD as shown in Figure 2 [37]. In a study by Toloza, vitamin D insufficiency was found in 66 [59][60][61][62]. Levels of 25(OH)D3 were also found to be negatively correlated to CRP and ESR [62].…”

Relationship Between Serum 25 Hydroxy Vitamin D Levels and Disease Activity in Patients with Rheumatoid Arthritis

“…Bu nedenle D vitamini yetersizliğin-de enfeksiyonların ve otoimmün hastalıkların görülme riski artmaktadır [8] . Kronik inflamatuvar romatizmal hastalıklar içinde özellikle romatoid artritte serum 25 hidroksi (OH) D vitamini eksikliğinin yüksek hastalık aktivitesi ile ilişkili olduğuna dair çalışmalar mevcut olmakla birlikte bu konu literatürde henüz netlik kazanmamıştır [9][10][11] . Bu çalışmanın amacı, RA hastalarında serum 25 (OH) D vitamini düzeyinin Disease Activity Score (DAS) 28 skoru ile ölçülen hastalık aktivitesi, demografik özellikler ve laboratuvar parametreleri ile ilişkisini incelemektir.…”

Systemic Osteoporosis and Psoriatic Arthritis: Current Understanding of the Problem

“…Однако работы по изучению содержания витамина D у пациентов с ПсА немногочислены. Результаты этих исследований сви-детельствуют о более низком уровне витамина D у та-ких больных по сравнению со здоровыми лицами [22,[32][33][34]. Так, например, работа, представленная ис-панскими авторами [34], продемонстрировала одина-ковую частоту дефицита витамина D у больных РА, анкилозирующим спондилитом и ПсА (40,5; 39,7 и 40,9% соответственно), которая была достоверно выше, чем у лиц без хронических воспалительных ревматических заболевний (26,7%).…”

“…Результаты этих исследований сви-детельствуют о более низком уровне витамина D у та-ких больных по сравнению со здоровыми лицами [22,[32][33][34]. Так, например, работа, представленная ис-панскими авторами [34], продемонстрировала одина-ковую частоту дефицита витамина D у больных РА, анкилозирующим спондилитом и ПсА (40,5; 39,7 и 40,9% соответственно), которая была достоверно выше, чем у лиц без хронических воспалительных ревматических заболевний (26,7%). Бивариантный анализ показал, что больные ПсА с дефицитом вита-мина D достоверно меньше времени проводили на солнце и реже дополнительно принимали препараты витамина D и кальция, а также чаще страдали ожире-нием [34].…”