Vitamin D Status and Psoriatic Arthritis: Association with the Risk for Sacroiliitis and Influence on the Retention Rate of Methotrexate Monotherapy and First Biological Drug Survival—A Retrospective Study

Abstract

A growing body of evidence on the importance of vitamin D in immune modulation has increased the interest in its possible impact on the course of rheumatological diseases. The scope of our study is to assess if the presence of different statuses of vitamin D could interfere in the clinical subsets, in methotrexate monotherapy discontinuation, and biological drug (b-DMARDs) survival in psoriatic arthritis patients (PsA). We conducted a retrospective study on PsA patients and split them into three groups based on their vitamin D status: the group with 25(OH)D ≤ 20 ng/mL, the group with levels of 25(OH)D between 20 and 30 ng/mL, and the group with serum levels of 25(OH)D ≥ 30 ng/mL. All patients were required to fulfill the CASPAR criteria for psoriatic arthritis and to have the evaluation of vitamin D serum levels at baseline visit and at clinical follow-up visits. The exclusion criteria were ages less than 18 years old, the presence of HLA B27, and satisfaction of rheumatoid arthritis classification criteria (during the study time). Statistical significance was set at p ≤ 0.05. Furthermore, 570 patients with PsA were screened and 233 were recruited. A level of 25(OH)D ≤ 20 ng/mL was present in 39% of patients; levels of 25(OH)D between 20 and 30 ng/mL presented in 25% of patients; 65% of patients with sacroiliitis presented 25 (OH)D ≤ 20 ng/mL. Methotrexate monotherapy discontinuation for failure was higher in the group with 25 (OH)D ≤ 20 ng/mL (survival time: 92 ± 10.3 weeks vs. 141.9 ± 24.1 weeks vs. 160.1 ± 23.6 weeks; p = 0.02) with higher discontinuation risk (HR = 2.168, 95% CI 1.334, 3.522; p = 0.002) than those with 25(OH)D between 20 and 30 ng/mL and those with 25(OH)D ≥ 30 ng/mL. Significantly shorter survival of first b-DMARDs was assessed in the group with 25 (OH)D ≤ 20 ng/mL versus the other groups (133.6 ± 11 weeks vs. 204.8 ± 35.8 weeks vs. 298.9 ± 35.4; p = 0,028) (discontinuation risk 2.129, 95% CI 1.186, 3.821; p = 0.011). This study highlights significant differences in clinical presentation, in particular sacroiliac involvement and on drug survival (methotrexate and b-DMARDs) in PsA patients with vitamin D deficiency. Further prospective studies, including a larger sample of patients, are needed to validate these data and to assess if the supplementation of vitamin D could improve the b-DMARDs response in PsA patients.

Vitamin D Status in Egyptian Patients With Psoriatic Arthritis and Its Relationship With the Disease Activity and Severity.

“…In harmony, Rotondo et al 26 noted a high frequency of axial affection in the psoriatic patients with vitamin D deficiency which go hand by hand with Fernandes et al 27 who considered presence of axial affection as indicator of disease severity. 28 noticed that vitamin D level was significantly linked to the functional ability in psoriatic arthritis that supports our findings.…”

“…On the contrary, Rotondo et al 26 showed that vitamin D level was not correlated with inflammatory markers, furthermore, Ibrahim et al 19 and Sag˘et al 25 reported that vitamin D level was not correlated with CRP.…”

The 2023’s Growing Evidence Confirming the Relationship between Vitamin D and Autoimmune Diseases

“…In a retrospective study involving 233 PsA patients, 25(OH)D 3 ≤ 20 ng/dL has been associated with a higher discontinuation rate of both conventional disease-modifying antirheumatic drugs (cDMARD (methotrexate), p = 0.02) and first biological DMARDs (p = 0.02) when compared to 25(OH)D 3 > 20 ng/dL [16].…”