Abstract
Over the last decade vitamin D (Vit D) has been the focus of considerable interest as a potential immunomodulator in a variety of conditions including autoimmune disease. Its influence in juvenile idiopathic arthritis (JIA) however is unclear. We therefore wished to clarify a possible link with the currently available evidence. A systematic literature review was undertaken using Embase, Cochrane and Medline for manuscripts up to May 2011. Search results were then assessed by two independent reviewers and relevant articles were further screened by full text review. Only those specifically reporting Vit D levels or its supplementation in JIA (ages between 0 and 18 years) were selected. Meta-analysis was performed where possible with those papers reporting similar data and analysis techniques. In total, 19 papers (n = 745) were included in the review. Fourteen papers quoted 25(OH)D levels within their study groups with a mean of 24.56 ng/ml (range, 11.5–56.4 ng/ml) in a total of 529 children. Eleven papers quoted 1,25(OH)2D levels with a mean of 31.09 pg/ml (range 6.1–65.0 pg/mol) in a total of 518 children. Three studies reporting the prevalence of Vit D deficiency in their cohorts found that up to 82 % of children had insufficient levels. Five papers reported Vit D levels by JIA subtype and showed lower levels of both 25(OH)D [mean 15.35, range 8.5–24.5 ng/ml] and 1,25(OH)2D [ mean 22.89, range 5.6–50 pg/ml] in systemic JIA. Four papers reported Vit D supplementation in JIA however the treatment effect was unclear. At present no clear evidence exists to support a link between Vit D level and JIA. Furthermore, the role of Vit D supplementation in the management of JIA is lacking. Despite Vit D levels appearing to be lower in JIA, interpretation is problematic as no agreed definition of Vit D deficiency exists in this population. A need remains therefore to standardise Vit D levels in the paediatric population and in JIA.
Similar content being viewed by others
References
Helmick CG, Felson DT, Lawrence RC et al (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States part I. Arthritis Rheum 58:15–25
Nistala K et al (2009) Juvenile idiopathic arthritis. In: Firestein GS et al (eds) Kelley's textbook of rheumatology, vol 2, 8th edn. Saunders Elsevier, Philadelphia, pp 1657–1675
Ellis JA, Munro JE, Ponsonby AL (2010) Possible environmental determinants of juvenile idiopathic arthritis. Rheumatology 49:411–425
Adorini L, Penna G (2008) Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 4:404–412
Szodoray P, Nakken B, Gaal J et al (2008) The complex role of vitamin D in autoimmune diseases. Scand J Immunol 68:261–269
Cutolo M, Otsa K, Uprus M et al (2007) Vitamin D in rheumatoid arthritis. Autoimmun Rev 7(1):59–64
Stark LJ, Davis AM, Janick DM et al (2006) A randomized clinical trial of dietary calcium to improve bone accretion in children with juvenile rheumatoid arthritis. J Pediatr 148:501–507
Elsasser U, Wilkins B, Hesp R et al (1982) Bone rarefaction and crush fractures in juvenile chronic arthritis. Arch Dis Child 57:377–380
McNally JD, Matheson LA, Rosenberg AM et al (2009) Epidemiologic considerations in unexplained pediatric arthralgia: the role of season, school, and stress. J Rheumatol 36:427–433
Siamopoulou A, Challa A, Kapoglou P et al (2001) Effects of intranasal salmon calcitonin in juvenile idiopathic arthritis: an observational study. Calcif Tissue Int 69:25–30
Warady BD, Lindsley CB, Robinson FG et al (1994) Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy. J Rheumatol 21:530–535
Tzoufi M, Siamopoulou-Mavridou A, Challa A et al (1994) Changes of mineral metabolism in juvenile chronic arthritis. Acta Paediatr Suppl 394:52–57
Falcini F, Ermini M, Bagnoli F et al (1998) Bone turnover is reduced in children with juvenile rheumatoid arthritis. J Endocrinol Invest 21:31–36
Henderson CJ, Cawkwell GD, Specker BL et al (1997) Predictors of total body bone mineral density in non-corticosteroid-treated prepubertal children with juvenile rheumatoid arthritis. Arthritis Rheum 40:1967–1975
Reed A, Haugen M, Pachman LM et al (1991) 25-Hydroxyvitamin D therapy in children with active juvenile rheumatoid arthritis: short-term effects on serum osteocalcin levels and bone mineral density. J Pediatr 119:657–660
Hillman LS, Cassidy JT, Chanetsa F et al (2008) Percent true calcium absorption, mineral metabolism, and bone mass in children with arthritis: effect of supplementation with vitamin D3 and calcium. Arthritis Rheum 58(10):3255–3263
Carrasco R, Lovell DJ, Giannini EH et al (2008) Biochemical markers of bone turnover associated with calcium supplementation in children with juvenile rheumatoid arthritis: results of a double-blind, placebo-controlled intervention trial. Arthritis Rheum 58:3932–3940
Rooney M, Davies UM, Reeve J et al (2000) Bone mineral content and bone mineral metabolism: changes after growth hormone treatment in juvenile chronic arthritis. J Rheumatol 27:1073–1081
Reeve J, Loftus J, Hesp R et al (1993) Biochemical prediction of changes in spinal bone mass in juvenile chronic (or rheumatoid) arthritis treated with glucocorticoids. J Rheumatol 20:1189–1195
Reed A, Haugen M, Pachman LM et al (1990) Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases. J Pediatr 116:574–580
Bianchi ML, Bardare M, Caraceni MP et al (1990) Bone metabolism in juvenile rheumatoid arthritis. Bone Miner 9:153–162
Lien G, Selvaag AM, Flato B et al (2005) A two-year prospective controlled study of bone mass and bone turnover in children with early juvenile idiopathic arthritis. Arthritis Rheum 52:833–840
Pepmueller PH, Cassidy JT, Allen SH et al (1996) Bone mineralization and bone mineral metabolism in children with juvenile rheumatoid arthritis. Arthritis Rheum 39:746–757
Reed AM, Haugen M, Pachman LM et al (1993) Repair of osteopenia in children with juvenile rheumatoid arthritis. J Pediatr 122:693–696
Hillman L, Cassidy JT, Johnson L et al (1994) Vitamin D metabolism and bone mineralization in children with juvenile rheumatoid arthritis. J Pediatr 124:910–916
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
FM and PC are co-second authors having contributed equally to the manuscript
Rights and permissions
About this article
Cite this article
Nisar, M.K., Masood, F., Cookson, P. et al. What do we know about juvenile idiopathic arthritis and vitamin D? A systematic literature review and meta-analysis of current evidence. Clin Rheumatol 32, 729–734 (2013). https://doi.org/10.1007/s10067-012-2159-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-012-2159-1