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Vitamin D levels and bone mass in rheumatoid arthritis

A Letter to the Editor - Food for Thought to this article was published on 10 January 2015

Abstract

Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease with high prevalence of osteoporosis. Previous evidence indicates an association between vitamin D deficiency and autoimmune diseases. The aim of this study was to evaluate serum 25 hydroxyvitamin D [25(OH)D] levels, bone mineral density (BMD) and disease activity in RA patients living in Argentina. We studied 34 RA women and 41 healthy women as a control group. RA patients had lower 25(OH)D levels (20.4 ± 0.9 ng/ml) than controls (26.3 ± 1.9 ng/ml; p < 0.05). No significant differences were found in lumbar spine BMD between premenopausal (preM) or postmenopausal (postM) patients, but femoral neck BMD was significantly lower in postM RA patients (T score −2.5 ± 0.4) than in postM control subjects (T score −0.9 ± 0.3, p = 0.014). Although no linear correlation between 25(OH)D levels and disease activity (DAS-28) was found, patients with moderate-high disease activity had lower 25(OH)D levels than those with low disease activity: DAS-28 >3.2: 19.5 ± 0.88 ng/ml; DAS-28 ≤3.2: 23.7 ± 2.8 ng/ml (p = 0.047). After 1 year of vitamin D treatment 25(OH)D levels were increased while DAS-28 were decreased (n = 25; p < 0.05). We conclude that patients with RA had lower 25(OH)D levels than the control group. Low levels of 25(OH)D were associated with moderate-high disease activity suggesting the importance of optimal 25(OH)D levels in RA patients. Femoral neck BMD was lower in postM RA patients. No differences in lumbar BMD were found between preM and postM RA patients, suggesting that bone mass evaluation in RA patients should include femoral neck BMD regardless of age.

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References

  1. Lodder MC, de Jong Z, Kostense PJ et al (2004) Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Ann Rheum Dis 63:1576–1580

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Cutolo M (2009) Vitamin D and autoimmune rheumatic diseases. Rheumatology (Oxford) 48:210–212

    Article  CAS  Google Scholar 

  3. Baykal T, Senel K, Alp F, Erdal A, Ugur M (2012) Is there an association between serum 25-hydroxyvitamin D concentrations and disease activity in rheumatoid arthritis? Bratisl Lek Listy 113:610–611

    CAS  PubMed  Google Scholar 

  4. Attar SM (2012) Vitamin D deficiency in rheumatoid arthritis. Prevalence and association with disease activity in Western Saudi Arabia. Saudi Med J 33:520–525

    PubMed  Google Scholar 

  5. Turhanoğlu AD, Güler H, Yönden Z, Aslan F, Mansuroğlu A, Ozer C (2011) The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int 31:911–914

    Article  PubMed  Google Scholar 

  6. 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 Rheumatol 24:702–704

    CAS  PubMed  Google Scholar 

  7. 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:R216

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Andjelkovic Z, Vojinovic J, Pejnovic N et al (1999) Disease modifying and immunomodulatory effects of high dose 1α(OH) D3 in rheumatoid arthritis patients. Clin Exp Rheumatol 17:453–456

    CAS  PubMed  Google Scholar 

  9. Chen J, Liu W, Lin Q, Chen L, Yin J, Huang H (2014) Vitamin D deficiency and low bone mineral density in native Chinese rheumatoid arthritis patients. Int J Rheum Dis 17(1):66–70

    Article  PubMed  Google Scholar 

  10. Vis M, Haavardsholm EA, Bøyesen P et al (2011) High incidence of vertebral and non-vertebral fractures in the OSTRA cohort study: a 5-year follow-up study in postmenopausal women with rheumatoid arthritis. Osteoporos Int 22:2413–2419

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. van Staa TP, Leufkens HG, Abenhaim L, Zhang B, Cooper C (2000) Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford) 39:1383–1389

    Article  Google Scholar 

  12. Ghazi M, Kolta S, Briot K, Fechtenbaum J, Paternotte S, Roux C (2012) Prevalence of vertebral fractures in patients with rheumatoid arthritis: revisiting the role of glucocorticoids. Osteoporos Int 23:581–587

    Article  CAS  PubMed  Google Scholar 

  13. Gravallese EM, Harada Y, Wang JT, Gorn AH, Thornhill TS, Goldring SR (1998) Identification of cell types responsible for bone resorption in rheumatoid arthritis and juvenile rheumatoid arthritis. Am J Pathol 152:943–951

    PubMed Central  CAS  PubMed  Google Scholar 

  14. Colin EM, Asmawidjaja PS, van Hamburg JP et al (2010) 1,25-dihydroxyvitamin D3 modulates Th17 polarization and interleukin-22 expression by memory T cells from patients with early rheumatoid arthritis. Arthritis Rheum 62:132–142

    Article  CAS  PubMed  Google Scholar 

  15. Aletaha D, Neogi T, Silman AJ et al (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum 62:2569–2581

    Article  PubMed  Google Scholar 

  16. Fransen J, van Riel PL (2005) The disease activity score and the EULAR response criteria. Clin Exp Rheumatol 23:S93–S99

    CAS  PubMed  Google Scholar 

  17. van Gestel AM, Haagsma CJ, van Riel PL (1998) Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum 41:1845–1850

    Article  PubMed  Google Scholar 

  18. Ross AC, Manson JE, Abrams SA et al (2011) The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab 96:53–58

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Sánchez A, Oliveri B, Mansur JL, Fradinger E, Mastaglia S (2013) Diagnosis, prevention, and treatment of hipovitaminosis D. A practical guide. Argentine Federation of Endocrine Societies. Rev Arg Endocrinol Metab 50:140–156

    Google Scholar 

  20. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy (2001) Osteoporosis Prevention, Diagnosis, and Therapy. JAMA 285:785–795

    Article  Google Scholar 

  21. Binkley N, Bilezikian JP, Kendler DL, Leib ES, Lewiecki EM, Petak SM (2006) International society for clinical densitometry. Official positions of the international society for clinical densitometry and executive summary of the 2005 position development conference. J Clin Densitom 9:4–14

    Article  PubMed  Google Scholar 

  22. Gopinath K, Danda D (2011) Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naive early rheumatoid arthritis: a randomised controlled trial. Int J Rheum Dis 14:332–339

    Article  PubMed  Google Scholar 

  23. Baker JF, Baker DG, Toedter G, Shults J, Von Feldt JM, Leonard MB (2012) Associations between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis. Clin Exp Rheumatol 30:658–664

    PubMed  Google Scholar 

  24. Haga HJ, Schmedes A, Naderi Y, Moreno AM, Peen E (2013) Severe deficiency of 25-hydroxyvitamin D(3) (25-OH-D (3)) is associated with high disease activity of rheumatoid arthritis. Clin Rheumatol 32:629–633

    Article  PubMed  Google Scholar 

  25. Higgins MJ, Mackie SL, Thalayasingam N, Bingham SJ, Hamilton J, Kelly CA (2013) The effect of vitamin D levels on the assessment of disease activity in rheumatoid arthritis. Clin Rheumatol 32:863–867

    Article  CAS  PubMed  Google Scholar 

  26. Song GG, Bae SC, Lee YH (2012) Association between vitamin D intake and the risk of rheumatoid arthritis: a meta-analysis. Clin Rheumatol 31:1733–1739

    Article  PubMed  Google Scholar 

  27. Craig SM, Yu F, Curtis JR, Alarcón GS et al (2010) Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol 37:275–281

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Mastaglia SR, Seijo M, Muzio D, Somoza J, Nuñez M, Oliveri B (2011) Effect of vitamin D nutritional status on muscle function and strength in healthy women aged over sixty-five years. J Nutr Health Aging 15:349–354

    Article  CAS  PubMed  Google Scholar 

  29. Haque UJ, Bartlett SJ (2010) Relationships among vitamin D, disease activity, pain and disability in rheumatoid arthritis. Clin Exp Rheumatol 28:745–747

    CAS  PubMed  Google Scholar 

  30. Hitchon CA, Sun Y, Robinson DB et al (2012) Vitamin D receptor polymorphism rs2228570 (Fok1) is associated with rheumatoid arthritis in North American natives. J Rheumatol 39:1792–1797

    Article  CAS  PubMed  Google Scholar 

  31. Huybers S, Naber TH, Bindels RJ, Hoenderop JG (2007) Prednisolone-induced Ca2+ malabsorption is caused by diminished expression of the epithelial Ca2+ channel TRPV6. Am J Physiol Gastrointest Liver Physiol 292:G92–G97

    Article  CAS  PubMed  Google Scholar 

  32. Zallone A (2006) Direct and indirect estrogen actions on osteoblasts and osteoclasts. Ann N Y Acad Sci 1068:173–179

    Article  CAS  PubMed  Google Scholar 

  33. Canalis E, Mazziotti G, Giustina A, Bilezikian JP (2007) Glucocorticoid-induced osteoporosis: pathophysiology and therapy. Osteoporos Int 18:1319–1328

    Article  CAS  PubMed  Google Scholar 

  34. Sugiguchi S, Goto H, Inaba M, Nishizawa Y (2010) Preferential reduction of bone mineral density at the femur reflects impairment of physical activity in patients with low-activity rheumatoid arthritis. Mod Rheumatol 20:69–73

    Article  PubMed  Google Scholar 

  35. Gilboe IM, Kvien TK, Haugeberg G, Husby G (2000) Bone mineral density in systemic lupus erythematosus: comparison with rheumatoid arthritis and healthy controls. Ann Rheum Dis 59:110–115

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  36. Oliveri B, Di Gregorio S, Parisi MS, Solís F, Mautalen C (2003) Is ultrasound of bone relevant for corticosteroid-treated patients? A comparative study with bone densitometry measured by DEXA. Joint Bone Spine 70:46–51

    Article  PubMed  Google Scholar 

  37. Dirven L, van den Broek M, van Groenendael JH et al (2012) Prevalence of vertebral fractures in a disease activity steered cohort of patients with early active rheumatoid arthritis. BMC Musculoskelet Disord 13:125

    Article  PubMed Central  PubMed  Google Scholar 

  38. Mohammad A, Lohan D, Bergin D et al (2013) The prevalence of vertebral fracture on vertebral fracture assessment imaging in a large cohort of patients with rheumatoid arthritis. Rheumatology (Oxford)

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Acknowledgments

This work was funded by a grant of Alberto J. Roemmers Fundation.

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All authors have no conflict of interests.

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Correspondence to María L. Brance.

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Brance, M.L., Brun, L.R., Lioi, S. et al. Vitamin D levels and bone mass in rheumatoid arthritis. Rheumatol Int 35, 499–505 (2015). https://doi.org/10.1007/s00296-014-3071-6

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  • DOI: https://doi.org/10.1007/s00296-014-3071-6

Keywords

  • Vitamin D
  • Bone mass
  • Rheumatoid arthritis
  • Disease activity