AB1128 Vitamin d status in patients with juvenile idiopathic arthritis

Abstract

Background 25-hydroxy-vitamin D [25(OH) D] insufficiency/deficiency has been associated with many chronic diseases. There are only a few studies in the literature that have analyzed vitamin D status in juvenile idiopathic arthritis (JIA). Objectives Our purpose was to assess the prevalence and associations of 25(OH) D insufficiency/deficiency in children’s and adults with JIA. Methods We have recruited 40 patients with JIA according to the criteria of the International League of Associations for Rheumatology (ILAR). Age, gender, disease duration, radiological joint destructive changes and medical treatments were collected. Questionnaires were performed to evaluate mean sun exposure time and dietary intake of vitamin D. In all we evaluated the current Disease Activity Score for 28 joints (DAS 28). From November 2011 until January 2012, blood samples were drawn in all patients, and phosphorus, calcium, alkaline phosphatase, ESR, CRP and serum 25(OH) D levels were measured. Serum levels between 20-30 ng/ml were classified as vitamin D insufficiency and levels <20 ng/ml as vitamin D deficiency. None of the patients were receiving vitamin D supplementation at the time of or during the year prior to study entry. In the statistical analysis (chi-Square and student T-test for categorical and continuous variables, respectively), a significant association was considered if p<0.05. Results We have evaluated 31 females and 9 males, with a mean age of 22.3 (4-63 years) and disease duration of 14.6±12.1. Regarding the dietary intake, we found that 32.5% had high intake of vitamin D and 27.5% had normal values, while 40% had insufficient intake. The mean sun exposure time throughout the last year was 77.4 minutes/day. The blood levels of calcium, phosphorus and alkaline phosphatase were normal in all patients. We found low levels of vitamin D in 75% of patients:the prevalence of 25(OH) D insufficiency and deficiency were 47.5% and 27.5%, respectively. JIA patients with less sun exposure and higher ESR had significantly lower vitamin D levels. We also found that patients who had greater joint destruction had lower levels of vitamin D, although not statistically significant (p=0.07). There was no association between vitamin D levels and gender, disease duration, intake of vitamin D, CRP, therapy with corticosteroids, number of DMARDs and biological agents per patient or the current DAS28. Conclusions Our study demonstrated that the prevalence of vitamin D deficiency/insufficiency among JIA patients is very high. Although there is a tendency for patients with more joint destruction to present lower levels of vitamin D, sun exposure and ESR seem to be the most important factors. A limitation of this study was the fact that it was performed during winter, when sun daily availability is lower. Future larger, long-term studies evaluating patients with JIA are needed to further elucidate the association between serum 25(OH)D levels and disease activity. Disclosure of Interest None Declared

Vitamin D and juvenile idiopathic arthritis

“…Obese children had significantly reduced 25(OH)D compared to normal weight peers. Negative relationship between MTX use and 25(OH)D. Oporto, Portugal Peixoto et al 2013 Conference Abstract 41°N [ 30 ] JIA n = 40 (31) 22.3 (4–63) 10 > 75 nmol/L, 19 between 50 and 75 nmol/L, 11 < 20 nmol/L Prevalence of vitamin D deficiency/insufficiency among JIA patients is very high. Antalya, Turkey Comak et al 2014 36°N [ 32 ] JIA n = 47 (29) 9.3 ± 3.9 44.2 ± 29.0 Only 27.7% patients had 25(OH)D > 50 nmol/L.…”

“…Seventeen studies used a cross-sectional design ( n = 17; 44.7%) [ 27 – 30 , 32 – 35 , 37 , 42 , 44 , 51 , 53 , 57 – 59 ], 16 (42.1%) a case-control design [ 21 – 26 , 31 , 39 , 41 , 43 , 47 – 50 , 60 ] and the remainder (5; 13.2%) were randomized controlled trials [ 40 , 45 , 46 , 54 , 55 ]. The primary objective of the majority of studies was to investigate the relationship between juvenile arthritis and bone health ( n = 20; 52.6%).…”

“…Of the 38 studies reviewed, six (15.8%) had mean 25(OH)D concentrations above 75 nmol/L [ 28 , 42 , 44 , 45 , 53 , 54 ]. Seventeen studies (44.7%) had mean 25(OH)D concentrations between 50 and 75 nmol/L [ 22 , 23 , 25 , 27 , 30 , 33 , 34 , 36 , 37 , 39 , 40 , 46 – 48 , 55 , 59 ] and 15 (39.5%) had values below 50 nmol/L [ 21 , 24 , 26 , 29 , 31 , 32 , 35 , 38 , 41 , 43 , 49 – 51 , 57 , 60 ]. Of those 15 studies, 10 reported the mean 25(OH)D value, the median value reported for one study and a range or cutoff was provided for four studies).…”

“…As illustrated in Fig. 2 , seven reviewed studies (18.4%) were conducted in populations residing at latitudes at or below 33° [ 22 , 25 , 27 , 28 , 31 , 39 , 60 ], 19 studies (50.0%) were conducted between 33 and 50° [ 21 , 23 , 30 , 32 , 36 , 40 – 48 , 50 , 54 , 55 , 57 , 66 ], and 12 at a latitude above 50° [ 24 , 26 , 29 , 34 , 35 , 37 , 38 , 49 , 51 , 53 , 59 ]. For those below 33°, 1 study (14.3%) reported a mean 25(OH)D concentration > 75 nmol/L, 4 (57%) reported a concentration between 50 and 75 nmol/L, and two (29%) reported values less than 50 nmol/L.…”

“…Of the 21 studies that applied the current chronic childhood arthritis criteria used by ILAR to diagnose children with JIA, only one study reported mean 25(OH)D concentrations above 75 nmol/L (15%) [ 28 ]. The majority of the studies ( n = 11; 52.4%) reported mean concentrations between 50 and 75 (52%) nmol/L [ 22 , 23 , 25 , 27 , 30 , 33 , 34 , 36 , 37 , 40 , 67 ], and the remaining studies ( n = 9; 42.9%) reported a mean concentration below 50 nmol/L (43%) [ 21 , 24 , 26 , 29 , 31 , 32 , 35 , 38 , 60 ]. As latitude increased, the percentage of studies that reported mean 25(OH)D in the 50–75 nmol/L range decreased.…”