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AB0368 Association of 25-Hydroxyvitamin D3 Serum Levels and Metabolic Parameters in Portuguese Patients with Established Rheumatoid Arthritis
  1. M. Bernardes1,
  2. M.J. Martins2,
  3. D. Rosa-Gonçalves1,
  4. R. Fonseca1,
  5. P. Madureira1,
  6. R. Vieira1,
  7. F. Aguiar1,
  8. F. Simões-Ventura3,
  9. L. Costa1
  1. 1Rheumatology, São João Hospital
  2. 2Biochemistry
  3. 3Rheumatology, Faculty of Medicine, University of Porto, Porto, Portugal

Abstract

Background Patients with rheumatoid arthritis (RA) are at higher risk for adverse cardiovascular events, an increase which is not completely explained by the presence of traditional risk factors. Vitamin D is an essential steroid hormone with an important role on mineral metabolism, skeletal health and on the cardiovascular and immune systems. Vitamin D seems to play a protective role against cardiovascular diseases, insulin resistance and obesity.

Objectives To assess the relationship of 25(OH)vitamin D3 (25(OH)vit.D) serum levels with lipid and glucose metabolism parameters in a Portuguese population of patients with established RA.

Methods For this study, clinical features and peripheral blood samples were collected from a monitoring visit of consecutive RA patients. The exclusion criteria were the use of anti-diabetic and/or anti-dyslipidemic therapies. The Portuguese version of HAQ-DI and the disease activity score (DAS28 (4v;ESR)) were obtained. We measured the following laboratory parameters: ESR and CRP, serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), triglycerides, apolipoprotein A1 (Apo A1), apolipoprotein B (Apo B), lipoprotein a (lpa), insulin, fasting glucose and uric acid. TC/HDL cholesterol (atherogenic or Castelli index), LDL/HDL cholesterol and Apo B/Apo A1 ratios were calculated. Insulin resistance was also determined (HOMA-IR). Serum 25(OH)vit.D levels were measured and its status established (<30 ng/mL: deficiency; ≥30 ng/mL: normal levels). A multivariate analysis model was used for statistical analysis (IBM SPSS Statistics 21).

Results We evaluated 156 RA patients, 126 (81%) women, 27 (17%) obese, 66 (43%) with overweight, 85 (55%) under biologics, 71 (46%) under TNF-alpha blockers, 31 (20%) under vitamin D supplements, age 51±11 years, 13±10 years of disease duration, mean DAS28(4v) of 4.17±1.39 and a mean HAQ of 1.172±0.709. Rheumatoid factor was positive in 61% (95) of the patients and anti-cyclic citrullinated peptide (anti-CCP) antibodies were positive in 78% (122). Only 53 (34%) of the patients exhibited adequate 25(OH)vit.D levels and 102 (66%) were 25(OH)vit.D deficient. We verified that 25(OH)vit.D deficiency was associated with higher serum levels of insulin and lpa (p<0.05). Additionally, 25(OH)vit.D deficiency was also associated with higher values of Apo B/Apo A1 ratio (p<0.05). It was observed a tendency for the association of lower 25(OH)vit.D levels with lower ApoA1 levels (p=0.056) and higher insulin resistance (p=0.070) in the serum. All these associations were found after adjusting for age, body mass index, current HAQ and current DAS28(4V; ESR).

Conclusions Our analysis supports the hypothesis of an association between vitamin D and several disturbances in glucose metabolism and lipid profile in established RA patients. However, this cross-sectional study did not permit the establishment of a causal relationship.

References

  1. Joshua F. Baker, Nehal N. Mehta, Daniel G. Baker, et al. Vitamin D, metabolic dyslipidemia, and metabolic syndrome in rheumatoid arthritis. American J Med. 2012; 125: 1036.e9-1036.e15

Disclosure of Interest None declared

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