Is vitamin D in rheumatoid arthritis a magic bullet or a mirage? The need to improve the evidence base prior to calls for supplementation

Welsh, Paul; Peters, Mike J L; Sattar, Naveed

doi:10.1002/art.30341

Cited by 34 publications

(21 citation statements)

References 59 publications

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“…In a recent article on rheumatoid arthritis and increased vitamin D supplementation, caution was advised before widespread adoption of supplementation with vitamin. They suggested, and we agree, that well-conducted large randomized controlled trials are necessary to establish the role of vitamin D (41) . This caution is especially important given that there is still controversy about the role of calcium and vitamin D in cardiovascular disease (30–32) .…”

Section: Discussionmentioning

confidence: 58%

Vitamin D in Systemic Lupus Erythematosus: Modest Association With Disease Activity and the Urine Protein‐to‐Creatinine Ratio

Petri

Bello

Fang

et al. 2013

Arthritis & Rheumatism

141

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Objective We investigated whether an increase in vitamin D levels in patients with systemic lupus erythematosus was associated with improvement in disease activity. Methods 1006 SLE patients were followed over 128 weeks. SLE patients with low levels of 25-hydroxy Vitamin D (<40 ng/mL) were supplemented with 50,000 units Vitamin D2 weekly, with Ca/D3 200 units twice daily. Longitudinal regression models were used to estimate the association between levels of vitamin D and various measures of disease activity. Results The SLE patients were 91% female, mean age 49.6, 54% Caucasian, 37% African-American and 8% other ethnicity. For those with low 25-hydroxy Vitamin D (<40 ng/mL), a 20 unit increase in 25-hydroxy Vitamin D was associated with a decrease in mean SELENA-SLEDAI by 0.22 (CI: −0.41, −0.02) (p= 0.032). This corresponded with a 21% decrease in the odds of having a SELENA-SLEDAI higher than 4 (CI: 1%, 37%). Mean urine protein-to-creatinine ratio decreased 2% (CI: −0.03, −0.01) (p=0.009), corresponding to a 15% decrease in the odds of having a ratio of 0.5 or greater (CI: 2%, 27%). Conclusion We found that a 20 ng/mL increase in vitamin D was associated with a 21% decrease in the odds of having a high activity score and a 15% decrease in the odds of having clinically important proteinuria. Though these associations were statistically significant, the clinical importance is relatively modest. There was no evidence of additional benefit beyond a level of 40 ng/mL.

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Section: Discussionmentioning

confidence: 58%

Vitamin D in Systemic Lupus Erythematosus: Modest Association With Disease Activity and the Urine Protein‐to‐Creatinine Ratio

Petri

Bello

Fang

et al. 2013

Arthritis & Rheumatism

141

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“…We have previously argued, as have others, that observational data may be confounded and subject to reverse causality, these limitations being of particular relevance for 25OHD [6][7][8].…”

Section: Introductionmentioning

confidence: 91%

25-Hydroxyvitamin D is lower in deprived groups, but is not associated with carotid intima media thickness or plaques: Results from pSoBid

et al. 2012

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ObjectiveThe association of the circulating serum vitamin D metabolite with atherosclerotic burden is unclear, with previous studies reporting disparate results. MethodPsychological, social and biological determinants of ill health (pSoBid) is a study of participants aged 35-64 years from Glasgow who live at extremes of the socioeconomic spectrum. Vitamin D deficiency was defined as 25OHD <25nmol/L, as per convention. Cross-sectional associations between circulating 25OHD concentrations and a range of socioeconomic, lifestyle, and biochemistry factors, as well as carotid intima media thickness (cIMT) and plaque presence were assessed in 625 participants. ResultsGeometric mean levels of circulating 25OHD were higher among the least deprived (45.6 nmol/L, 1-SD range 24.4-85.5) versus most deprived (34.2 nmol/L, 1-SD range 16.9-69.2; p<0.0001). In the least deprived group 15% were "deficient" in circulating 25OHD versus 30.8% in the most deprived (χ 2 p<0.0001). Log 25OHD was 27% lower among smokers (p<0.0001), 20% higher among the physically active versus inactive (p=0.01), 2% lower per 1kg/m 2 increase in body mass index (BMI) (p<0.0001), and showed expected seasonal variation (χ 2 p<0.0001).Log 25OHD was 13% lower in the most versus least deprived independent of the aforementioned ConclusionThere is no strong association of 25OHD with cIMT or plaque presence, despite strong evidence 25OHD associates with lifestyle factors and socioeconomic deprivation.

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“…Vitamin D, as a prohormone, is considered to be able to play potential immune-suppressive roles and to exert an endocrine action on the immune system cells, generating anti-inflammatory and immunoregulatory effects [3, 4]. …”

Section: Introductionmentioning

confidence: 99%

Evaluation of Vitamin D Status in Rheumatoid Arthritis and Its Association with Disease Activity across 15 Countries: “The COMORA Study”

Hajjaj–Hassouni

Mawani

Allali

et al. 2017

International Journal of Rheumatology

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The aims of this study are to evaluate vitamin D status in 1413 RA patients of COMORA study from 15 countries and to analyze relationship between patients' RA characteristics and low levels of vitamin D. All demographic, clinical, and biological data and RA comorbidities were completed. The results showed that the average of vitamin D serum dosage was 27.3 ng/mL ± 15.1 [0.1–151]. Status of vitamin D was insufficient in 54.6% and deficient in 8.5% of patients. 43% of RA patients were supplemented with vitamin D and absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency (p < 0.001). Finally, our study shows that the status of low levels of vitamin D is common in RA in different countries and under different latitudes. Absence of supplementation on vitamin D was related to higher prevalence of vitamin D deficiency. Low levels of vitamin D were associated with patients characteristics (age, BMI, and educational level), RA (disease activity and corticosteroid dosage), and comorbidities (lung disease and osteoporosis therapy). This suggests the need for a particular therapeutic strategy to improve vitamin D status in RA patients.

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Is vitamin D in rheumatoid arthritis a magic bullet or a mirage? The need to improve the evidence base prior to calls for supplementation

Cited by 34 publications

References 59 publications

Vitamin D in Systemic Lupus Erythematosus: Modest Association With Disease Activity and the Urine Protein‐to‐Creatinine Ratio

Vitamin D in Systemic Lupus Erythematosus: Modest Association With Disease Activity and the Urine Protein‐to‐Creatinine Ratio

25-Hydroxyvitamin D is lower in deprived groups, but is not associated with carotid intima media thickness or plaques: Results from pSoBid

Evaluation of Vitamin D Status in Rheumatoid Arthritis and Its Association with Disease Activity across 15 Countries: “The COMORA Study”

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