Severe deficiency of 25-hydroxyvitamin D 3 (25-OH-D 3 ) is associated with high disease activity of rheumatoid arthritis
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ORIGINAL ARTICLE
Severe deficiency of 25-hydroxyvitamin D3 (25-OH-D3) is associated with high disease activity of rheumatoid arthritis Hans-Jacob Haga & Anne Schmedes & Yusuf Naderi & Alicia Martin Moreno & Elisabeth Peen
Received: 29 August 2012 / Revised: 1 November 2012 / Accepted: 12 December 2012 / Published online: 15 January 2013 # Clinical Rheumatology 2013
Abstract This study aims to measure the serum level of 25hydroxyvitamin D3 (25-OH-D3) in 302 patients with rheumatoid arthritis (RA), studying the association to disease activity. Three hundred two RA patients underwent clinical examination and serological analysis. 25-Hydroxyvitamin D3 was determined by high-performance liquid chromatography–tandem mass spectrometry. Vitamin D3 deficiency defined as serum levels of 25-hydroxyvitamin D3 below 50 nmol/l was detected in 101 RA patients (33.4 %). There was no significant correlation between the serum level of 25-hydroxyvitamin D3 and Disease Activity Score 28 (DAS28) (3w) score. In a subpopulation of RA patients with very low serum level of 25-OH-D3 (≤15 nmol/l) (n=15), there were significant differences compared to patients with normal 25-OH-D3 (n=200): higher percentage of patients with positive rheumatoid factor (100.0 versus 77.5 %; p=0.05), higher CRP (28.7 versus 14.8 mg/l; p=0.001), higher number of patients treated with at least three disease-modifying antirheumatic drugs (DMARDs) (40.0 versus 14.5 %; p=0.02), higher number of patients with high disease activity DAS28 score of ≥5.1 (20.0 versus 4.5 %; p=0.01), lower age (54.5 versus 64.0 years; p=0.003) and shorter disease duration (5.1 versus 10.3 years; p=0.06). H.-J. Haga (*) : E. Peen Reumaklinik Danmark, Aalborg University Esbjerg, Havnegade 19, 6700, Esbjerg, Denmark e-mail: [email protected] A. Schmedes Department of Clinical Biochemistry, Lillebaelt Hospital, Vejle, Denmark Y. Naderi Department of Rheumatology, Sydvestjysk Sygehus, Esbjerg, Denmark A. M. Moreno Department of Urology, The National Hospital, Copenhagen, Denmark
Deficiency of 25-hydroxyvitamin D3 was detected in 33.4 % of the RA patients. A subpopulation of patients with severe deficiency of vitamin D3 serum level of ≤15 nmol/l was characterised by all being positive for rheumatoid factor, high percentage of patients with very high disease activity and high percentage of patients treated with at least three DMARDs. Keywords Disease activity . Rheumatoid arthritis . Vitamin D3 (25-OH-D3)
Introduction It has been suggested that vitamin D in its physiologically active form (1,25(OH)2D3) has immunoregulatory activities [1], in addition to being a hormone controlling the intestinal absorption of calcium and phosphorous [2]. The vitamin D receptor has been detected in the immune system such as mononuclear cells, dendritic cells, antigen-presenting cells and activated T-B lymphocytes, and in addition, activated dendritic cells produce vitamin D [3, 4]. Vitamin D status has been linked to several autoimmune diseases in humans. It has been demonstrated in the Women’s Iowa Hea
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