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Zeitschrift für Rheumatologie

, Volume 73, Issue 5, pp 461–464 | Cite as

Role of vitamin D in flare ups of rheumatoid arthritis

  • A. Dehghan
  • S. RahimpourEmail author
  • H. Soleymani-Salehabadi
  • M.B. Owlia
Originalien

Abstract

Introduction

Rheumatoid arthritis (RA) is one of the most prevalent autoimmune diseases worldwide. Some researchers have suggested that the serum vitamin D (Vit D) level may relate to disease activity. The current study was designed to identify the correlation between vitamin D prescription and prevention of relapses in rheumatoid arthritis.

Patients and method

A double blinded, randomized controlled trial study was performed using 80 RA patients. RA was controlled and patients were in remission during the past 2 months. Serum level of Vit D in the studied patients was below 30 ng/dl. Patients were randomly allocated to receive Vit D or placebo. In the 6-month follow-up period, the Disease Activity Score 28 (DAS28) was used in case of relapses as an index of RA activity to compare the two groups.

Results

The flare rate was not different between two groups (p > 0.05). The odds ratio of the rate of decline in patients of the trial group compared with the control group was 1.17 (not significant; p > 0.05). The mean DAS28 between the two patient groups was not significant (p > 0.05).

Conclusion

A low Vit D level was not identified to be a risk factor for RA severity or flare ups; however, although not statistically significant, Vit D treatment might be clinically effective. Further studies are needed with more emphasis on the issue of cost effectiveness and clinical importance to provide more information.

Keywords

Flare Rheumatoid arthritis Vitamin D Autoimmune diseases Vitamin D deficiency 

Rolle von Vitamin D bei Schüben der rheumatoiden Arthritis

Zusammenfassung

Einleitung

Die rheumatoide Arthritis (RA) gehört weltweit zu den häufigsten Autoimmunerkrankungen. Manche Forscher vermuten, dass die Aktivität der Erkrankung mit dem Vitamin-D-Spiegel im Serum zusammenhängt. In der vorliegenden Studie sollte die Beziehung zwischen der Verschreibung von Vitamin D und der Prävention von RA-Rezidiven ermittelt werden.

AbstractSection Stop

Patienten und Methoden

An 80 RA-Patienten wurde eine doppelblinde, randomisierte, kontrollierte Studie durchgeführt. Die Erkrankung war unter Kontrolle, die Patienten hatten sich in den vorausgegangenen 2 Monaten in Remission befunden. Der Serum-Vitamin-D-Spiegel lag bei den eingeschlossenen Patienten unter 30 ng/dl. Die Teilnehmer wurden in 2 Gruppen randomisiert. Eine erhielt Vitamin D, die andere Placebo. Im 6-monatigen Follow-up wurde im Falle eines Rezidivs der Disease Activity Score 28 (DAS28) herangezogen, um die beiden Gruppen bezüglich der RA-Aktivität zu vergleichen.

Ergebnisse

Die Gruppen unterschieden sich nicht hinsichtlich der Rate an Schüben (p > 0,05). Die Odds Ratio der Abnahme betrug für Patienten in der behandelten Gruppe im Vergleich zur Kontrollgruppe 1,17 (nicht signifikant; p > 0,05). Auch hinsichtlich des durchschnittlichen DAS28 fand sich in den beiden Gruppen keine Signifikanz (p > 0,05).

Schlussfolgerung

Ein niedriger Vitamin-D-Spiegel erwies sich nicht als Risikofaktor für Schübe oder die Schwere der RA. Allerdings könnte die Vitamin-D-Behandlung, wenn auch ohne statistische Signifikanz, klinisch wirksam sein. Weitere Studien mit stärkerem Gewicht auf der Kosteneffektivität und klinischen Bedeutung sind notwendig.

Schlüsselwörter

Schub Rheumatoide Arthritis Vitamin D Autoimmunerkrankung Vitamin-D-Mangel 

Notes

Acknowledgment

This project was supported by faculty of medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran as the dissertation of Dr. Shahab Rahimpour to graduate in internal medicine. We also are thankful to Dr. Masoud Rahimian and Dr. Mohammad Reza Mirjalili for their consultations.

Compliance with ethical guidelines

Conflict of interest. A. Dehghan, S. Rahimpour, H. Soleymani-Salehabadi, and M. Bagher Owlia state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

References

  1. 1.
    Gary S, Firestein (2005) Rheumatoid arthritis. In: Kelley S (ed) Text book of rheumatology. Elsevier Science, pp 996–1078Google Scholar
  2. 2.
    Turhanoğlu AD, Güler H, Yönden Z et al (2011) The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int 31:911–914PubMedCrossRefGoogle Scholar
  3. 3.
    Boekel MA van, Vossenaar ER, Hoogen FH van den, Venrooij WJ van (2002) Autoantibody systems in rheumatoid arthritis: specificity, sensitivity and diagnostic value. Arthritis Res 4(2):87–93PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Prietl B, Treiber G, Pieber TR, Amrein K (2013) Vitamin D and immune function. Nutrients 5(7):2502–2521PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 66(9):1137–1142PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Holick MF (2005) Vitamin D: important for prevention of osteoporosis, cardiovascular heart disease, type 1 diabetes, autoimmune diseases, and some cancers. South Med J 98(10):1024–1027PubMedCrossRefGoogle Scholar
  7. 7.
    Hollick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281CrossRefGoogle Scholar
  8. 8.
    Oelzner P, Muller A, Deschner F et al (1998) Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int 62(3):193–198PubMedCrossRefGoogle Scholar
  9. 9.
    Patel S, Farragher T, Berry J et al (2007) Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum 56(7):2143–2149PubMedCrossRefGoogle Scholar
  10. 10.
    Andjelkovic Z, Vojinovic J, Pejnovic N et al (1999) Disease modifying and immunomodulatory effects of high dose 1 alpha (OH) D3 in rheumatoid arthritis patients. Clin Exp Rheumatol 17:453–456PubMedGoogle Scholar
  11. 11.
    Cutolo M, Otsa K, Laas K et al (2006) Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp RheumatoI 24:702–704Google Scholar
  12. 12.
    May E, Asadullah K, Zügel U (2004) Immunoregulation through 1,25-dihydroxyvitamin D 3 and its analogs. Curr Drug Targets Inflamm Allergy 3(4):377–393PubMedCrossRefGoogle Scholar
  13. 13.
    Hein G, Oelzner P (2000) Vitamin D metabolism in rheumatoid arthritis: findings–hypotheses–consequences. Z RheumatoI 59:28–32CrossRefGoogle Scholar
  14. 14.
    http://www.4s-dawn.com/DAS28/. Accessed on 23 October 2013Google Scholar
  15. 15.
    Merlino LA, Curtis J, Mikuls TR et al (2004) Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 50(1):72–77PubMedCrossRefGoogle Scholar
  16. 16.
    Cantorna MT, Zhu Y, Froicu M, Wittke A (2004) Vitamin D status, 1,25-dihydroxy vitamin D3, and the immune system. Am J Clin Nutr 80:1717–1720Google Scholar
  17. 17.
    Harel M, Shoenfeld Y (2006) Predicting and preventing autoimmunity, myth or reality? Ann N Y Acad Sci 1069:322–345PubMedCrossRefGoogle Scholar
  18. 18.
    Costenbader KH, Feskanich D, Holmes M et al (2008) Vitamin D intake and risks of systemic lupus erythematous and rheumatoid arthritis in women. Ann Rheum Dis 67(4):530–535PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Nielen MM, Schaardenburg D van, Lems WF et al (2006) Vitamin D deficiency does not increase the risk of rheumatoid arthritis: comment on the article by Merlino et al. Arthritis Rheum 54(11):3719–3720PubMedCrossRefGoogle Scholar
  20. 20.
    Heshmat R, Mohammad K, Majdzadeh SR et al (2008) Vitamin D deficiency in Iran: a multi-center study among different urban areas Iran J Public Health 37:72–78Google Scholar
  21. 21.
    Hovsepian S, Amini M, Aminorroaya A et al(2011) Prevalence of Vitamin D deficiency among adult population of Isfahan City, Iran. J Health Popul Nutr 29(2):149–155PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Craig SM, Yu F, Curtis JR et al (2010) Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol 37(2):275–281PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Haque VJ, Bartleft SJ (2010) Relationships among vitamin D, disease activity, pain and disability in rheumatoid arthritis. Clin Exp Rheumatol 28(5):745–747PubMedGoogle Scholar
  24. 24.
    Kerr GS, Sabahi I, Richards JS et al (2011) Prevalence of vitamin D insufficiency/deficiency in rheumatoid arthritis and associations with disease severity and activity. J Rheumatol 38(1):53–59PubMedCrossRefGoogle Scholar
  25. 25.
    Rossini M, Maddali Bongi S, La Montagna G et al (2010) Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability. Arthritis Res Ther 12(6):R216PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Salesi M, Faraj-Zadegan Z, Karimifar M (2011) Is vitamin D effective on the disease activity index (DAS28) in rheumatoid arthritis? J Isfahan Med School 29:180–187Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • A. Dehghan
    • 1
  • S. Rahimpour
    • 2
    Email author
  • H. Soleymani-Salehabadi
    • 1
  • M.B. Owlia
    • 1
  1. 1.Rheumatology, Department of Internal MedicineShahid Sadoughi Hospital, Shahid Sadoughi University of Medical SciencesYazdIran
  2. 2.Resident in Internal Medicine, department of Internal MedicineShahid Sadoughi Hospital, Shahid Sadoughi University of Medical SciencesYazdIran

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