FRI0078 European Pilot Study on Vitamin D Serum Levels and Disease Activity in Rheumatoid Arthritis Patients

Abstract

Background Several studies have demonstrated low 25(OH)D3 serum levels, which could influence pathogenesis and clinical outcomes of immune-mediated diseases such as rheumatoid arthritis (RA) (1,2). Objectives In order to investigate the necessity to implement specific vitamin D patient related outcomes we performed a pilot European multicentre study, involving individuals from different countries/latitudes, to explore 25(OH)D3 serum levels and their possible correlation with disease activity and related outcomes in RA patients during winter season. Methods We enrolled 270 RA patients (not treated with vitamin D supplementation) and 180 healthy subjects as controls (CNT), from Rheumatology centers in 10 European countries. RA patients mean disease duration was 10±9 years and mean age 56±10 years. Patients informed consent was obtained before collecting blood samples. Complete medical history, health assessment questionnaire (HAQ), rheumatoid arthritis impact disease score (RAID), disease activity scale (DAS28) were recorded. 25(OH)D3 serum levels were evaluated centrally using chemiluminescence immunoassay with an automatic analyser (LIAISON, DiaSorin), and classified as normal (>30 ng/ml), insufficient (between 20 and 30 ng/ml) or deficient (<20 ng/ml) (3). Results 25(OH)D3 serum levels were significantly lower in RA patients compared to controls (median 16 vs 20 ng/ml) (p<0.0001). In particular, we registered 25(OH)D3 deficiency (<20 ng/ml) in 25% and insufficiency in 70% of RA patients. Male and female RA patients showed similar 25(OH)D3 values (median 19 vs 17 ng/ml) (p=n.s.). We found statistically significant difference in 25(OH)D3 levels between some European countries such as significantly higher 25(OH)D3 serum levels in Spanish RA patients (Canaries Islands) compared to patients from Latvia, Lithuania, Romania, Croatia, Russia and Italy (p<0.01). In agreement with previous observations (4), we found in RA patients statistically significant negative correlations between 25(OH)D3 values and HAQ (r=-0.29, p=0.03), RAID (r=-0.32, p=0.02), and DAS28 scores (r=-0.41, p=0.003), respectively. Conclusions The results of this multicentre study confirms, at least in winter time, the presence of significantly lower 25(OH)D3 serum levels in RA patients than in healthy control subjects, which seem correlated with disease activity at all latitudes in Europe. The significant negative correlations observed between 25(OH)D3 serum levels and DAS28, HAQ and RAID scores justify the need to develop specific questionnaires for patient reported outcomes (PRO) vitamin D-related, and to validate them in a large European multicentre study. References 1. Cutolo et al. Autoimmun Rev 2011;11:84-87. Aranow C. J Investig Med. 2011; 59: 881–886. 3. Holick MF. N Engl J Med 2007;357:266-81. 4. Cutolo M. Ann Rheum Dis 2013;72:473-5. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.4145

Relationship between Serum 25-Hydroxyvitamin D Levels, Disease Activity and Anti-Cyclic Citrullinated Peptide Antibody Levels in Indian Rheumatoid Arthritis Patients

“…Our findings are in concordance with the findings by Kostoglou-Athanassiou, et al [12], Rossini, et al [10], Haque and Bartlett [11]. Also, Welsh, et al [30], Cutolo, et al [31] and Kerr and colleagues [32] stated that 25-OH vitamin D deficiency is linked with increased disease activity in RA. However, other studies did not find a significant correlation between 25-OH vitamin D and RA activity scores [16,33,34].…”

Normal or Arthritic: Is 25-hydroxy Vitamin D status significant?

“…This is in concordance with previous observations wherein RA patients have significantly low level of vitamin D than healthy individuals 9,10 . Also, our data suggested that age factors could not be correlated with vitamin D levels in arthritic subjects suggesting that vitamin D level might be independent of age.…”

“…Some group of investigators found negative association between serum vitamin D level and RA disease 9,10 . In contrast, we could not find any correlation between vitamin D levels in normal and arthritic subjects.…”

Relationship between vitamin D3 level and rheumatoid arthritis patients attending Rizgary Teaching Hospital in Erbil city

“…And this result supported by Craig, et al 21 which failed to discover a statistically significant association between vitamin D3 and DAS28 following multivariate adjustments in recent-onset rheumatoid arthritis patients. Cutolo, et al 22 found a remarkable negative correlation between vitamin D3 and DAS28 in summer only in Southern European (Italian) patients and in winter in northern European (Estonian) patients, but no significant differences with respect to vitamin D3 values between Estonian and Italian RA patients and their controls. Research which doesn't agree with my result in disease activity and vitamin D3 are in an open-labeled randomized trial comparing triple disease-modifying antirheumatic drug (DMARD) therapy and 500 IU vitamin D3 + calcium combination versus triple DMARD and calcium alone by Gopinath et al, low levels of serum vitamin D3 were related to moderate-high disease activity in and supplementation of 500 IU of vitamin D3 daily was given to previously DMARD-naïve patients with early rheumatoid arthritis along with triple DMARD therapy showed significantly higher pain relief (50%vs.…”