Abstract
The objectives of this study are to assess the vitamin D status in patients (pts) with inflammatory joint diseases (IJD), and its correlation with disease activity. 121 consecutive pts (85 rheumatoid arthritis (RA), 22 psoriatic arthritis (PSA), 14 ankylosing spondylitis (AS)) underwent clinical and laboratory evaluation which included kidney and liver function tests, serum calcium and phosphor levels, 25(OH)D and parathyroid hormone (PTH). Disease activity was assessed by DAS 28 in RA and PSA pts and by BASDAI in AS pts, sedimentation rate (ESR) and CRP. According to activity indexes, pts were divided into subgroups with low (DAS28 < 3.2 and BASDAI < 4), and moderate-to-high disease activity (DAS28 > 3.2 and BASDAI > 4). Associations between serum levels of 25(OH)D and age, gender, ethnicity, type and disease duration, treatment, (anti-tumor necrosis factorα (TNFα) agents or DMARDs), seasonal variations, and disease activity were assessed. Vitamin D deficiency was found in 51 pts (42.1%). The incidence was higher among Arab pts (76.7%) compared to Jews (23%). The difference of 25(OH)D levels between Arabs (mean 9.4 ± 4.2 ng/ml) and Jews (mean 17.8 ± 8.4 ng/ml) was statistically significant (p < 0.0001). We did not find correlation between vitamin D levels and the other evaluated factors. A surprisingly high incidence of vitamin D deficiency was found in IJD patients in a sunny Mediterranean country. This finding justifies the inclusion of vitamin D in the routine lab work-up of pts with IJD. The only statistical significant correlation was found between vitamin D level and ethnic origin. Further studies are needed to look for genetic polymorphism of vitamin D receptors.
Similar content being viewed by others
References
Zitterman A (2003) Vitamin D in preventive medicine: are we ignoring the evidence? BJN 89:552–572
Hayes CE, Nashold FE, Spach KM, Pedersen LB (2003) The immunological functions of the vitamin D endocrine system. Cell Mol Biol 49:277–300
Muller K, Diamant M, Bendtzen K (1991) Inhibition of production and function of interleukin-6 by 1, 25-dihydroxy-vitamin D3. Immunol Lett 28:115–120
D’Ambrosio D, Cippitelli M, Cocciolo MG, Mazzeo D, Di Lucia P, Lang R, Sinigaglia F, Panina-Bordignon P (1998) Inhibition of IL-12 production by 1, 25-dihydroxy-vitamin D3. Involvement of NF-kappa B downregulation in transcriptional repression of the p40 gene. J Clin Invest 101:252–262
Rigby WF, Waugh M, Graziano RF (1990) Regulation of human monocyte HLA-DR and CD4 antigen expression, and antigen presentation by 1,25-dihydroxyvitamin D3. Blood 76(1):189–197
Lemire JM, Archer DC, Beck L, Spiegelberg HL (1995) Immunosuppressive actions of 1, 25-dihydroxyvitamin D3: preferential inhibition of Th 1 functions. J Nutr 125(Suppl 6):1704S–1708S
Arnson Y, Amital H, Shoenfeld Y (2007) Vitamin D and autoimmunity: new etiological and therapeutical considerations. Ann Rheum Dis 66:1137–1142
Fritsche J, Mondal K, Ehrensperger A et al (2003) Regulation of 25-hydroxy vitamin D3-1 alpha-hydroxylase and production of 1 alpha 25-dihydroxyvitamin D3 by human dendritic cells. Blood 102:3314–3316
Bouillon R, Bischoff-Ferrari H, Willett W (2008) Vitamin D and health: perspectives from mice and man. J Bone Miner Res 23(7):974–979
Aguado P, del Campo MT, Garces MV, Gonzalez-Casuas ML, Bernad M, Gijon-Banos J, Martin Mola E, Torrijos A, Martinez ME (2000) Low vitamin D levels in outpatient postmenopausal women from a rheumatology clinic in Madrid, Spain: their relationship with bone mineral density. Osteoporosis Int 11:739–744
Oelzner P, Muller A, Deschner F, Holler M, Abendroth K, Hein G, Stein G (1998) Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int 62:193–198
Jahnsen J, Falch JA, Mowinckel P, Aadland E (2002) Vitamin D status, parathyroid hormone and bone mineral density in patients with inflammatory bowel disease. Scand J Gastroenterol 37:192–199
Nieves J, Cosman F, Herbert J, Shen V, Lindsay R (1994) High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology 44:1687–1692
Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KG (2004) Vitamin D is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 50:72–77
Nielen MM, van Schaardenburg D, Lems WF, van de Stadt RJ, de Koning MH, Reesink HW, Habibuw MR, van der Horst-Bruinsma IE, Twisk JW, Dijkmans BA (2006) Vitamin D deficiency does not increase the risk of rheumatoid arthritis: comment on the article by Merlino et al. Arthritis Rheum 54(11):3719–3720
Garcia-Lozano JR, Gonzalez-Escribano MF, Valenzuela A, Garcia A, Nunez-Roldan A (2001) Association of vitamin D receptor genotypes with early onset rheumatoid arthritis. Eur J Immunogenet 28:89–93
Oelzner P, Müller A, Deschner F, Hüller M, Abendroth K, Hein G, Stein G (1998) Relationship between disease activity and serum levels of vitamin D metabolites and PTH in rheumatoid arthritis. Calcif Tissue Int 62(3):193–198
Kröger H, Penttilä IM, Alhava EM (1993) Low serum vitamin D metabolites in women with rheumatoid arthritis. Scand J Rheumatol 22(4):172–177
Lange U, Teichmann J, Strunk J, Muller-Ladner U, Schmidt KL (2005) Association of 1, 25 vitamin D3 deficiency, disease activity and low bone mass in ankylosing spondylitis. Osteoporosis Int 16:1999–2004
Cutolo M, Otsa K, Laas K et al (2006) Circannual vitamin D serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol 24:702–704
Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D (2007) Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum 56(7):2143–2149
Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, CASPAR Study Group (2006) Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 54:2665–2673
Van der Linden SM, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum 27:361–368
Prevoo ML, Van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL (1995) Modified Disease Activity Scores that include twenty-eight-joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 38:44–48
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisfrod P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21:2286–2291
Holick MF (2006) High prevalence of Vitamin D inadequacy and implications for health. Mayo Clin Proc 81(3):353–373
Hansen KE, Jones AN, Lindstrom MJ, Davis LA, Engelke JA, Shafer MM (2008) Vitamin D insufficiency: disease or no disease? J Bone Miner Res 23(7):1052–1060
Gaugris S, Heaney RP, Boonen S, Kurth H, Bentkover JD, Sen SS (2005) Vitamin D inadequacy among post-menopausal women: a systematic review. QJM. 98(9):667–676
Hollis BW (2000) Comparison of commercially available 125I-based methods for the determination of circulating 25-hydroxyvitamin D. Clin Chem 46:1657–1661
Binkley N, Krueger D, Cowgill L, Plum L, Lake E, Hansen KE et al (2004) Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization. J Clin Endocrinol Metab 89:3152–3157
Carter GD, Carter R, Jones J, Berry J (2004) How Accurate Are Assays for 25-Hydroxyvitamin D? Data from the International Vitamin D External Quality Assessment Scheme. Clin Chem 50:2195–2197
Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B (2006) Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Am J Clin Nutr 84:18–28
Heaney RP, Dowell MS, Hale CA, Bendich A (2003) Calcium absorption varies within the reference range for serum 25-hydroxyvitamin D. J Am Coll Nutr 22(2):142–146
Lowenthal MN, Shany S (1994) Osteomalacia among Bedouin women of the Negev. Isr J Med Sci 30:520–523
Hasid R, Tamir A, Raz B, Segal E, Ish Shalom S (2002) Impaired vitamin D status in young Israeli women. J Bone Miner Res 17(Suppl 1):S267
Mukamel MN, Weisman Y, Somech R et al (2001) Vitamin D deficiency and insufficiency in orthodox and non-orthodox Jewish mothers in Israel. IMAJ 3:419–421
Dawodu A, Absood G, Patel M, Agarwal M, Ezimokhai M, Abdulrazzaq Y, Khalayli G (1998) Biosocial factors affecting vitamin D status of women of childbearing age in the United Arab Emirates. J Biosoc Sci 30(4):431–437
Kristal-Boneh E, Froom P, Harari G, Ribak J (1999) Seasonal changes in calcitropic hormones in Israeli men. Eur J Epidemiol 15(3):237–244
Hochwald O, Harman-Boehm I, Castel H (2004) Hypovitaminosis D among inpatients in a sunny country. Isr Med Assoc J 6(2):82–87
Hochberg MC, Chang RW, Dwosh I et al (1992) The American College of Rheumatology 1991 revised criteria for the classification of global functional status in rheumatoid arthritis. Arthritis Rheum 35:498–502
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Braun-Moscovici, Y., Toledano, K., Markovits, D. et al. Vitamin D level: is it related to disease activity in inflammatory joint disease?. Rheumatol Int 31, 493–499 (2011). https://doi.org/10.1007/s00296-009-1251-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00296-009-1251-6