Background Vitamin D3 (vitD) deficiency has been associated with an increased risk of a wide range of acute and chronic diseases including rheumatic diseases. Low serum 25(OH)D levels has been reported in mediterranean countries but little is known about the sunny island of Cyprus.1,2
Objectives To assess vitamin D status among Cypriot patients with various rheumatic diseases (RD) and non-inflammatory musculoskeletal disorders (MSD).
Methods Serum levels of 25(OH)D were randomly measured in 277 Cypriot patients with RD and MSD who attended the rheumatology outpatient clinics at the General hospitals of Larnaca and Ammochostos in 2016. 84/277 patients were receiving vitD supplements and excluded from analysis. From the rest 193 patients (female/male [F/M]:151/42, mean age:58, rage:21–89), 69 had rheumatoid arthritis (RA) (F/M:54/15, mean age:62, range 27–83), 31 seronegative spondyloarthropathies (SpA) (F/M:13/18, mean age:54, rage:21–73), 65 MSD (e.g. osteoarthritis, back pain, neck pain, arthralgia) (F/M:61/4, mean age 56, range 21–82), 16 autoimmune diseases (lupus, sjogren's, scleroderma) (F/M:15/1, mean age:61, rage:45–79)) and 12 various other RD (F/M:8/4, mean age 55, rage 21–89). 20 patients had additionally Hashimoto's thyroiditis (F/M:18/2, mean age:56, rage:28–73).
Results The mean serum vitD levels in all patients were 20.4 ng/ml (range 3.2–56.8 ng/ml). VitD deficiency (<20 ng/ml) was found in 122/193 patients (63%), insufficiency (21 to 29 ng/ml) in 49/193 patients (25%) and sufficiency (>30 ng/ml) in 22/193 patients (11%).3 The mean values (range) of vitD levels and the percentage of patients that had vitD deficiency, insufficiency and sufficiency per disease category were; RA: 19.8 ng/mL (8.1–53.3 ng/ml), 64%, 28% and 9% respectively, spa: 21.9 ng/ml (7.2–54.0 ng/mL), 48%, 35% and 16% respectively, MSD: 20.3 ng/ml (6.6–48.0 ng/ml), 63%, 28% and 9% respectively, autoimmune diseases: 17.9 ng/ml (3.20–37.00 ng/ml), 81%, 6% and 13% respectively, other RD: 22.7 ng/ml (9.0–56.8 ng/ml), 75%, 0%, 25% respectively and Hashimoto's thyroiditis: 18.8 ng/ml (7.2–37.0 ng/ml), 80%, 5% and 15% respectively. Analysis of the total number of patients showed significant differences in vitD levels and rates of vitD deficiency among females and males (19.3 ng/mL, [range 3.2–54.0 ng/mL], vs 23.7ng/mL, [range 7.2–56.8 ng/mL] [p=0.009] and 70% vs 43% respectively). Seasonal variations or age-related differences in vitD levels were not observed in this study.
Conclusions High rates of vitD deficiency were observed in patients with RD and MSD in the island of Cyprus despite the sunny climate. Avoidance of sun exposure is presumed to be the main reason. Further studies are needed.
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González-Gross et al. Br J Nutr. 2012;107(5):755–64.
Hossein-nezhad et al.Mayo Clin Proc. 2013;88(7):720–755.
Disclosure of Interest None declared