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Cieślewicz A, Korzeniowska K, Grabańska-Martyńska K, Jabłecka A, Hrycaj P. Seasonal and Treatment-Related Variation in 25-Hydroxy Vitamin D Concentration in Patients with Rheumatoid Arthritis. J Clin Med 2024; 13:973. [PMID: 38398286 PMCID: PMC10889237 DOI: 10.3390/jcm13040973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Background/Objectives: 25-hydroxy vitamin D (25-OH-D) is a fat-soluble compound that plays many essential functions, including bone formation, neuromuscular functions, and prevention of osteoporosis and inflammation. Recent data indicate that its metabolites are associated with rheumatoid arthritis (RA) progression and neuropathic pain in RA patients. We aimed to assess the effect of RA pharmacotherapy and seasonal variation on serum levels of 25-OH-D in RA patients who received treatment with methotrexate (MTX) or leflunomide (LEF) for at least one year. Methods: This study is a retrospective analysis of data collected from 101 patients with RA who received treatment for at least one year. All of them have supplemented 25-OH-D (2000 IU daily) for at least one year. Results: We observed a significant seasonal variation in 25-OH-D concentration (p = 0.004). Moreover, there were significant differences (p = 0.03) between LEF (50.63 ± 17.73 ng/mL) and MTX (34.73 ± 14.04 ng/mL) treatment groups, but only for the summer population. A correlation was observed between 25-OH-D and RA duration-once again, in the summer population (the whole group-r = -0.64; treatment subgroups-r = -0.82 for LEF and -0.61 for MTX). Deficiency of 25-OH-D (below 20 ng/mL) was confirmed in 28.7% of patients, while 18.8% had suboptimal 25-OH-D levels (20-30 ng/mL). Conclusions: Our results showed that both RA pharmacotherapy and seasonal variation affect the serum levels of 25-OH-D in patients with active RA.
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Affiliation(s)
- Artur Cieślewicz
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, 61-861 Poznan, Poland; (K.K.); (A.J.)
| | - Katarzyna Korzeniowska
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, 61-861 Poznan, Poland; (K.K.); (A.J.)
| | - Katarzyna Grabańska-Martyńska
- Department of Internal Medicine, Poznan University of Medical Sciences, 61-861 Poznan, Poland;
- Department of Rheumatology, District Hospital in Koscian, 64-000 Koscian, Poland;
| | - Anna Jabłecka
- Department of Clinical Pharmacology, Poznan University of Medical Sciences, 61-861 Poznan, Poland; (K.K.); (A.J.)
| | - Paweł Hrycaj
- Department of Rheumatology, District Hospital in Koscian, 64-000 Koscian, Poland;
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Tv P, Kumar B, Chidambaram Y, Thangavelu S. Correlation of Rheumatoid arthritis disease severity with serum vitamin D levels. Clin Nutr ESPEN 2023; 57:697-702. [PMID: 37739725 DOI: 10.1016/j.clnesp.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIM Rheumatoid arthritis (RA) is an autoimmune disorder marked by characteristic inflammation of the small joints in addition to diverse systemic manifestations. Vitamin D has immunomodulatory properties, and its deficiency has a significant role in the clinical course of RA. The present research was conducted to study the correlation between serum vitamin D levels and disease activity scores in RA patients. METHODS A cross sectional study was carried out on a sample of 50 patients presenting with RA. Disease activity was measured using Modified Disease Activity Score (DAS) criteria. Estimation of serum Vitamin D levels were done using the electrochemiluminescence method and values less than 20 ng/ml were considered as deficiency. Vitamin D levels were then correlated with disease activity scores. RESULTS The Vitamin D deficiency was observed in 50% of the study population. Rheumatoid arthritis showed female preponderance in this study. Inflammatory markers such as C - reactive protein (CRP) levels and Erythrocyte Sedimentation Rate (ESR) did not differ with RA disease activity. More the number of large joints involved lesser were the vitamin D levels. There was an inverse correlation between Vitamin D levels and RA disease activity. CONCLUSION Vitamin D deficiency is significantly correlated with disease severity of RA. This study points to the importance of screening for deficit of vitamin D among RA patients and treat it as early as possible.
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Affiliation(s)
- Padmapriya Tv
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu 641004, India.
| | - Bhargavi Kumar
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu 641004, India.
| | - Yoganathan Chidambaram
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu 641004, India.
| | - Saravanan Thangavelu
- Department of Medicine, PSG Institute of Medical Sciences & Research, Coimbatore, Tamil Nadu 641004, India.
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Zou J, Zhu L, Yang J, Feng J, Li S, Luo J, Li M, Ren Y, Dong J, Zhang Y, Tian L. Correlation between vitamin D metabolites and rheumatoid arthritis with osteoporosis by ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). J Bone Miner Metab 2022; 40:696-703. [PMID: 35648223 DOI: 10.1007/s00774-022-01337-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/20/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Our aim is to study the correlation between vitamin D metabolites and osteoporosis in rheumatoid arthritis (RA) by ultra-high-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). At the same time, other influencing factors and serum biomarkers of osteoporosis in patients with RA were studied. MATERIALS AND METHODS Patients with RA admitted from January 2020 to December 2020 were selected at our hospital. The subjects were divided into the normal bone mineral density (BMD), osteopenia, and osteoporosis groups. The differences of vitamin D (VD) metabolites among groups were compared. The Pearson correlation coefficient was used to analyze the relationship between BMD and various parameters. The relationship between BMD and influencing factors was studied by a multiple linear regression equation. RESULTS A total of 287 patients with RA were included. RA patients with 25-hydroxy vitamin D [25(OH)D] deficiency accounted for 43.63% and 25(OH)D insufficient levels accounted for 31.37%. There were 31 cases (10.80%) in the normal BMD group, 161 cases (56.10%) in the osteopenia group, and 95 cases (33.10%) in the osteoporosis group. The BMD of L1-4 (T- score) was negatively correlated with age (P < 0.05), course of disease (P < 0.05), and erythrocyte sedimentation rate (ESR) (P < 0.05), and positively correlated with 25(OH)D3 (P < 0.05). The multiple linear regression model results showed that age and 25(OH)D3 were independent predictors of BMD; this explained 22.11% of the total variation. CONCLUSIONS VD deficiency and insufficient are common in RA patients. RA patients can be appropriately supplemented with VD. VD3 may be a better choice.
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Affiliation(s)
- Jinmei Zou
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Lungang Zhu
- Department of Emergency, Mianyang Central Hospital, Mianyang, China
| | - Jing Yang
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China.
| | - Jiafu Feng
- Department of Clinical Laboratory, Mianyang Central Hospital, Mianyang, China
| | - Siyin Li
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Jiaang Luo
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Min Li
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Yan Ren
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Jianling Dong
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Yu Zhang
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
| | - Lan Tian
- Department of Rheumatology and Immunology, Mianyang Central Hospital, No.12 Changjiaxiang, Jingzhong Street, Fucheng District, Mianyang, 621000, China
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Kowalski EN, Qian G, Vanni KMM, Sparks JA. A Roadmap for Investigating Preclinical Autoimmunity Using Patient-Oriented and Epidemiologic Study Designs: Example of Rheumatoid Arthritis. Front Immunol 2022; 13:890996. [PMID: 35693829 PMCID: PMC9175569 DOI: 10.3389/fimmu.2022.890996] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Background & Aims Rheumatoid arthritis (RA) is a prototypic autoimmune disease causing inflammatory polyarthritis that affects nearly 1% of the population. RA can lead to joint destruction and disability along with increased morbidity and mortality. Similar to other autoimmune diseases, RA has distinct preclinical phases corresponding to genetic risk, lifestyle risk factors, autoantibody development, and non-specific symptoms prior to clinical diagnosis. This narrative review will detail observational studies for RA risk and clinical trials for RA prevention as a roadmap to investigating preclinical autoimmunity that could be applied to other diseases. Methods In this narrative review, we summarized previous and ongoing research studies investigating RA risk and prevention, categorizing them related to their design and preclinical phases. Results We detailed the following types of studies investigating RA risk and prevention: retrospective population-based and administrative datasets; prospective studies (case-control and cohort; some enrolling based on genetics, first-degree relative status, elevated biomarkers, or early symptoms/arthritis); and randomized clinical trials. These correspond to all preclinical RA phases (genetic, lifestyle, autoimmunity, early signs/symptoms). Previous and ongoing randomized controlled trials have enrolled individuals at very elevated risk for RA based on biomarkers, symptoms, imaging abnormalities, or early signs/symptoms. Conclusion We detailed the rich variety of study designs that is necessary to investigate distinct preclinical phases of an autoimmune disease such as RA. However, further progress is needed to fully elucidate the pathogenesis of RA that may ultimately lead to prevention or delay of disease onset.
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Affiliation(s)
- Emily N Kowalski
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Grace Qian
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Kathleen M M Vanni
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States
| | - Jeffrey A Sparks
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Harvard Medical School, Boston, MA, United States
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