Background Vitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity.
Objectives 1. To study the relationship between vitamin D deficiency and disease activity at RA onset. 2. To investigate possible influence of vitamin D supplementation on disease activity in early RA patients.
Methods We studied 81 consecutive patients with new RA onset (71,6% women, mean age 60±14 years) admitted to the Department of Internal Medicine and Rheumatology, Military Institute of Medicine in Warsaw. Demographic, clinical, laboratory, and treatment variables were collected. The patients were treated with methotrexate, low dose of glucocorticoids and supplemented with vitamin D. Disease activity was assessed every month during the first year of therapy using DAS28-ESR, DAS28-CRP, CDAI, SDAI indices. Serum 25-hydroxy- vitamin D (25(OH)D3) was measured at baseline, after 6 and 12 months. Ultrasound assessment of hand joints was performed by the same assesssor at baseline and after 12 months. We defined vitamin D serum concentration <20ng/mL as vitamin D insufficiency and serum concentration <10ng/mL as vitamin D deficiency. New erosions found at ultrasound examination after 12 months were considered disease progression.
Results At baseline mean 25(OH)D3 serum concentration was 14,6±7,7ng/mL. Sufficient vitamin D serum concentration was found in 22% patients, 49% of patients had vitamin D insufficiency and 29% were vitamin D deficient. The patients with vitamin D deficiency at baseline had significantly higher number of tender and swollen joints, higher physician global assessment and higher number of joint effusion detected by ultrasound examination than other patients. There were no significant differences in ESR and CRP values according to vitamin D concentration. After 12 months (the data available for 65 patients) 20,3% of the patients had still insufficient vitamin D concentration and 4,7% were vitamin D deficient. Taking into account the mean vitamin D concentration during observation period only 52,4% of patients were vitamin D sufficient. New erosions in ultrasound examination were found in 14 (21,5%) patients. We have found no significant difference between vitamin D sufficient and insufficient patients according to the average indices of disease activity, disease activity improvement, time to achieve remission, duration of the remission and disease progression during the first year of therapy.
Conclusions Higher disease activity at RA onset is associated with lower serum vitamin D concentration. Vitamin D supplementation does not improve disease outcome during the first year of therapy.
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K. Gopinath, D. Donda. Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naïve early rheumatoid arthritis: a randomized controlled trial. International Journal of Rheumatic Diseases 2011;4: 332–339
Disclosure of Interest None declared