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25-Hydroxyvitamin D levels and juvenile idiopathic arthritis: Is there an association with disease activity?

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Abstract

The aims of this study were to examine the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and disease activity in juvenile idiopathic arthritis (JIA), to determine the prevalence of vitamin D (VD) deficiency [25(OH)D ≤19 ng/ml] and insufficiency [25(OH)D 20–29 ng/ml], and to determine factors associated with lower serum levels of 25(OH)D in this population. In this cross-sectional study, disease activity was measured using JADAS-27, as well as its individual components (physician global assessment of disease activity, parent global assessment of child’s well-being, count of joints with active disease, and erythrocyte sedimentation rate). Linear regression models were developed to analyze the association between serum 25(OH)D levels and JADAS-27 and to determine variables associated with serum 25(OH)D levels. A total of 154 patients (61% girls, 88% whites) were included. Mean age was 10.6. VD deficiency was detected in 13% and insufficiency in 42%. In univariate and multivariate analyses, 25(OH)D levels were not associated with JADAS-27, neither with its individual components. However, in a subset analysis including all new-onset JIA patients (n = 27), there was a nonsignificant negative correlation between serum 25(OH)D levels and JADAS-27 (r = −0.29, P = 0.14). In the univariate and multivariate analyses, age, ethnicity, BMI, and season were significantly associated with serum 25(OH)D levels, but not total VD intake. More than 1/2 of JIA patients had serum 25(OH)D levels below 29 ng/ml; however, there was no association between serum 25(OH)D levels and disease activity. Future larger, long-term studies with new-onset JIA patients are needed to further explore the association between serum 25(OH)D levels and disease activity.

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References

  1. Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis 66(9):1137–1142. doi:10.1136/ard.2007.069831

    Article  PubMed  CAS  Google Scholar 

  2. Cantorna MT, Yu S, Bruce D (2008) The paradoxical effects of vitamin D on type 1 mediated immunity. Mol Aspects Med 29(6):369–375. doi:10.1016/j.mam.2008.04.004

    Article  PubMed  CAS  Google Scholar 

  3. Chen S, Sims GP, Chen XX, Gu YY, Lipsky PE (2007) Modulatory effects of 1, 25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol 179(3):1634–1647. doi:179/3/1634

    PubMed  CAS  Google Scholar 

  4. Jirapongsananuruk O, Melamed I, Leung DY (2000) Additive immunosuppressive effects of 1, 25-dihydroxyvitamin D3 and corticosteroids on TH1, but not TH2, responses. J Allergy Clin Immunol 106(5):981–985. doi:10.1067/mai.2000.110101

    Article  PubMed  CAS  Google Scholar 

  5. Lemire J (2000) 1, 25-Dihydroxyvitamin D3—a hormone with immunomodulatory properties. Z Rheumatol 59(Suppl 1):24–27

    Article  PubMed  CAS  Google Scholar 

  6. Lemire JM, Archer DC, Beck L, Spiegelberg HL (1995) Immunosuppressive actions of 1, 25-dihydroxyvitamin D3: preferential inhibition of Th1 functions. J Nutr 125(6 Suppl):1704S–1708S

    PubMed  CAS  Google Scholar 

  7. van Etten E, Mathieu C (2005) Immunoregulation by 1, 25-dihydroxyvitamin D3: basic concepts. J Steroid Biochem Mol Biol 97(1–2):93–101. doi:10.1016/j.jsbmb.2005.06.002

    Article  PubMed  Google Scholar 

  8. van Halteren AG, Tysma OM, van Etten E, Mathieu C, Roep BO (2004) 1 alpha, 25-dihydroxyvitamin D3 or analogue treated dendritic cells modulate human autoreactive T cells via the selective induction of apoptosis. J Autoimmun 23(3):233–239. doi:10.1016/j.jaut.2004.06.004

    Article  PubMed  Google Scholar 

  9. Pelajo CF, Lopez-Benitez JM, Miller LC (2010) Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev 9(7):507–510. doi:10.1016/j.autrev.2010.02.011

    Article  PubMed  CAS  Google Scholar 

  10. Cutolo M, Otsa K, Paolino S, Yprus M, Veldi T, Seriolo B (2009) Vitamin D involvement in rheumatoid arthritis and systemic lupus erythaematosus. Ann Rheum Dis 68(3):446–447. doi:10.1136/ard.2008.093476

    Article  PubMed  CAS  Google Scholar 

  11. Kamen D, Aranow C (2008) Vitamin D in systemic lupus erythematosus. Curr Opin Rheumatol 20(5):532–537. doi:10.1097/BOR.0b013e32830a991b

    Article  PubMed  CAS  Google Scholar 

  12. Carvalho JF (2007) Anti-vitamin D, vitamin D in SLE. Ann N Y Acad Sci 1109:550–557

    Article  PubMed  CAS  Google Scholar 

  13. Muller K, Kriegbaum NJ, Baslund B, Sorensen OH, Thymann M, Bentzen K (1995) Vitamin D3 metabolism in patients with rheumatic diseases: low serum levels of 25-hydroxyvitamin D3 in patients with systemic lupus erythematosus. Clin Rheumatol 14(4):397–400

    Article  PubMed  CAS  Google Scholar 

  14. Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C (2008) Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford) 47(6):920–923. doi:10.1093/rheumatology/ken121

    Article  CAS  Google Scholar 

  15. Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS (2006) Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev 5(2):114–117. doi:10.1016/j.autrev.2005.05.009

    Article  PubMed  CAS  Google Scholar 

  16. Borba VZ, Vieira JG, Kasamatsu T, Radominski SC, Sato EI, Lazaretti-Castro M (2009) Vitamin D deficiency in patients with active systemic lupus erythematosus. Osteoporos Int 20(3):427–433. doi:10.1007/s00198-008-0676-1

    Article  PubMed  CAS  Google Scholar 

  17. Becker A, Fischer R, Schneider M (2001) Bone density and 25-OH vitamin D serum level in patients with systemic lupus erythematosus. Z Rheumatol 60(5):352–358

    Article  PubMed  CAS  Google Scholar 

  18. Cutolo M, Otsa K, Uprus M, Paolino S, Seriolo B (2007) Vitamin D in rheumatoid arthritis. Autoimmun Rev 7(1):59–64. doi:10.1016/j.autrev.2007.07.001

    Article  PubMed  CAS  Google Scholar 

  19. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG (2004) Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 50(1):72–77. doi:10.1002/art.11434

    Article  PubMed  CAS  Google Scholar 

  20. Costenbader KH, Feskanich D, Holmes M, Karlson EW, Benito-Garcia E (2008) Vitamin D intake and risks of systemic lupus erythematosus and rheumatoid arthritis in women. Ann Rheum Dis 67(4):530–535. doi:10.1136/ard.2007.072736

    Article  PubMed  CAS  Google Scholar 

  21. Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D (2007) Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum 56(7):2143–2149. doi:10.1002/art.22722

    Article  PubMed  CAS  Google Scholar 

  22. Cutolo M, Otsa K, Laas K, Yprus M, Lehtme R, Secchi ME, Sulli A, Paolino S, Seriolo B (2006) Circannual vitamin d serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol 24(6):702–704. doi:1964

    PubMed  CAS  Google Scholar 

  23. Oelzner P, Muller A, Deschner F, Huller M, Abendroth K, Hein G, Stein G (1998) Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int 62(3):193–198

    Article  PubMed  CAS  Google Scholar 

  24. Lange U, Teichmann J, Strunk J, Muller-Ladner U, Schmidt KL (2005) Association of 1.25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis. Osteoporos Int 16(12):1999–2004. doi:10.1007/s00198-005-1990-5

    Article  PubMed  CAS  Google Scholar 

  25. Ravelli A, Martini A (2007) Juvenile idiopathic arthritis. Lancet 369(9563):767–778. doi:10.1016/S0140-6736(07)60363-8

    Article  PubMed  CAS  Google Scholar 

  26. Pelajo CF, Lopez-Benitez JM, Miller LC (2011) 25-Hydroxyvitamin D Levels and vitamin D deficiency in children with rheumatologic disorders and controls. J Rheumatol 38:2000–2004. doi:10.3899/jrheum.110123

    Article  PubMed  CAS  Google Scholar 

  27. Bianchi ML, Bardare M, Caraceni MP, Cohen E, Falvella S, Borzani M, DeGaspari MG (1990) Bone metabolism in juvenile rheumatoid arthritis. Bone Miner 9(2):153–162

    Article  PubMed  CAS  Google Scholar 

  28. Consolaro A, Ruperto N, Bazso A, Pistorio A, Magni-Manzoni S, Filocamo G, Malattia C, Viola S, Martini A, Ravelli A (2009) Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum 61(5):658–666. doi:10.1002/art.24516

    Article  PubMed  Google Scholar 

  29. Cannell JJ, Hollis BW, Zasloff M, Heaney RP (2008) Diagnosis and treatment of vitamin D deficiency. Expert Opin Pharmacother 9(1):107–118. doi:10.1517/14656566.9.1.107

    Article  PubMed  CAS  Google Scholar 

  30. Mark S, Gray-Donald K, Delvin EE, O’Loughlin J, Paradis G, Levy E, Lambert M (2008) Low vitamin D status in a representative sample of youth from Quebec, Canada. Clin Chem 54(8):1283–1289. doi:10.1373/clinchem.2008.104158

    Article  PubMed  CAS  Google Scholar 

  31. Zittermann A (2003) Vitamin D in preventive medicine: are we ignoring the evidence? Br J Nutr 89(5):552–572. doi:10.1079/BJN2003837

    Article  PubMed  CAS  Google Scholar 

  32. Update (1997) Prevalence of overweight among children, adolescents, and adults–United States, 1988–1994. MMWR Morb Mortal Wkly Rep 46(9):198–202

  33. Harris SS, Dawson-Hughes B (1998) The association of oral contraceptive use with plasma 25-hydroxyvitamin D levels. J Am Coll Nutr 17(3):282–284

    PubMed  CAS  Google Scholar 

  34. Heaney RP (2005) The vitamin D requirement in health and disease. J Steroid Biochem Mol Biol 97(1–2):13–19. doi:10.1016/j.jsbmb.2005.06.020

    Article  PubMed  CAS  Google Scholar 

  35. Holick MF (2004) Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr 80(6 Suppl):1678S–1688S. doi:80/6/1678S

    PubMed  CAS  Google Scholar 

  36. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281. doi:10.1056/NEJMra070553

    Article  PubMed  CAS  Google Scholar 

  37. Mansbach JM, Ginde AA, Camargo CA Jr (2009) Serum 25-hydroxyvitamin D levels among US children aged 1 to 11 years: do children need more vitamin D? Pediatrics 124(5):1404–1410. doi:10.1542/peds.2008-2041

    Article  PubMed  Google Scholar 

  38. Greer FR (2009) Defining vitamin D deficiency in children: beyond 25-OH vitamin D serum concentrations. Pediatrics 124(5):1471–1473. doi:10.1542/peds.2009-2307

    Article  PubMed  Google Scholar 

  39. Tsai CL, Camargo CA Jr (2009) Methodological considerations, such as directed acyclic graphs, for studying “acute on chronic” disease epidemiology: chronic obstructive pulmonary disease example. J Clin Epidemiol 62(9):982–990. doi:10.1016/j.jclinepi.2008.10.005

    Article  PubMed  Google Scholar 

  40. Ish-Shalom S, Segal E, Salganik T, Raz B, Bromberg IL, Vieth R (2008) Comparison of daily, weekly, and monthly vitamin D3 in ethanol dosing protocols for two months in elderly hip fracture patients. J Clin Endocrinol Metab 93(9):3430–3435. doi:10.1210/jc.2008-0241

    Article  PubMed  CAS  Google Scholar 

  41. Saurenmann RK, Rose JB, Tyrrell P, Feldman BM, Laxer RM, Schneider R, Silverman ED (2007) Epidemiology of juvenile idiopathic arthritis in a multiethnic cohort: ethnicity as a risk factor. Arthritis Rheum 56(6):1974–1984. doi:10.1002/art.22709

    Article  PubMed  CAS  Google Scholar 

  42. Schwartz MM, Simpson P, Kerr KL, Jarvis JN (1997) Juvenile rheumatoid arthritis in African Americans. J Rheumatol 24(9):1826–1829

    PubMed  CAS  Google Scholar 

  43. Holick MF (2003) Vitamin D: a millenium perspective. J Cell Biochem 88(2):296–307. doi:10.1002/jcb.10338

    Article  PubMed  CAS  Google Scholar 

  44. Dong Y, Pollock N, Stallmann-Jorgensen IS, Gutin B, Lan L, Chen TC, Keeton D, Petty K, Holick MF, Zhu H (2010) Low 25-hydroxyvitamin D levels in adolescents: race, season, adiposity, physical activity, and fitness. Pediatrics 125(6):1104–1111. doi:10.1542/peds.2009-2055

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Dr. Caitlin Sgarlat and Dr. Trevor Davis for the assistance with data collection. The project described was supported by Award Number UL1 RR025752 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Division of Pediatric Rheumatology, Floating Hospital for Children at Tufts Medical Center, 800 Washington St Box #190, Boston, MA, 02111, USA

    Christina F. Pelajo, Jorge M. Lopez-Benitez & Laurie C. Miller

  2. Tufts University School of Medicine, Boston, MA, USA

    Jorge M. Lopez-Benitez, David M. Kent, Laurie C. Miller & Bess Dawson-Hughes

  3. Sackler School of Graduate Biomedical Sciences, Tufts University, Boston, MA, USA

    David M. Kent

  4. Biostatistics Research Center in the Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts University, Boston, MA, USA

    Lori Lyn Price

  5. Bone Metabolism Laboratory, Jean Mayer USDA HNRCA at Tufts University, Boston, MA, USA

    Bess Dawson-Hughes

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  1. Christina F. Pelajo
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Correspondence to Christina F. Pelajo.

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Pelajo, C.F., Lopez-Benitez, J.M., Kent, D.M. et al. 25-Hydroxyvitamin D levels and juvenile idiopathic arthritis: Is there an association with disease activity?. Rheumatol Int 32, 3923–3929 (2012). https://doi.org/10.1007/s00296-011-2287-y

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  • DOI: https://doi.org/10.1007/s00296-011-2287-y

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