Vitamin D Status in Egyptian Patients with Rheumatoid Arthritis

Abstract

Background: Vitamin D is a potent regulator of calcium homeostasis and may have immunomodulatory effects. The influence of vitamin D on human autoimmune disease has not been well defined. The aim of this cross sectional study was to estimate the prevalence and determinants of vitamin D deficiency in patients with rheumatoid arthritis as compared to healthy controls and to analyze the association between 25-hydroxyvitamin D with disease activity.

Methods: The study includes 55 consecutive rheumatoid arthritis patients and 25 healthy controls, not on vitamin D supplements. Together with parameters of disease activity, all patients had serum 25-hydroxyvitamin D [25(OH)D] measured by ELISA kit in a centralized laboratory. Disease activity in rheumatoid arthritis was assessed by Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ). According to activity indexes, patients were divided into subgroups with high activity of the disease (DAS28>5.1), moderate activity of the disease (3.2<DAS28≤5.1), low activity of disease (2.6≤DAS28≤3.2) and remission (DAS28<2.60). Associations between serum levels of 25(OH)D and age, disease duration and activity were assessed.

Results: 25-hydroxyvitamin D deficiency, insufficiency and sufficiency were found in 16.00, 4.00 and 80.00% of controls, respectively, while, 25(OH)D insufficiency and sufficiency were found in 21.80 and 78.20% of rheumatoid arthritis patients, respectively with no significant difference between groups (P<0.918). According to DAS28 scoring, 9.10% of patients showed remission (DAS28<2.6), 7.30% showed low disease activity (2.6≤DAS28≤3.2), 63.60% showed moderate activity (3.2<DAS28≤5.1) and 20.00% showed high disease activity (DAS28>5.1). Disease duration was significantly longer in patients with moderate disease activity vs. those with low and high disease activity (P< 0.026 and P<0.001, respectively). 25(OH)D levels were lower in moderate disease activity vs. those with remission (P<0.014). DAS28 and HAQ were significantly higher in patients with high disease activity than remission, low disease activity and moderate disease activity. DAS28 and HAQ were significantly higher in patients with moderate disease activity than remission and those with low disease activity. A significant negative correlation was found in rheumatoid arthritis patients between 25(OH)D and ESR.

Conclusions: In rheumatoid arthritis patients, vitamin D deficiency is quite common, but similar to that found in control subjects; disease activity (expressed as ESR) is inversely related to 25(OH)D levels.

Zusammenfassung

Hintergrund: Vitamin D ist ein potenter Regulator der Kalzium Hämostase und hat möglicherweise immunmodulatorische Effekte. Der Einfluss von Vitamin D auf Autoimmunerkrankungen ist nicht gut untersucht. Ziel dieser Querschnittsstudie war die Einschätzung der Prävalenz und die Determinanten des Vitamin D Mangels bei Patienten mit rheumatoider Arthritis im Vergleich zu gesunden Kontrollen sowie die Analyse der Assoziation zwischen 25-Hydroxyvitamin D und der Krankheitsaktivität.

Methoden: Die Studie inkludierte 55 konsekutive Patienten mit rheumatoider Arthritis und 25 gesunde Kontrollen, die kein Vitamin D einnahmen. Zusätzlich zu Krankheitsaktivitätsparametern erhielten alle Patienten Serum 25-Hydroxyvitamin D [25(OH)D] Analysen anhand eines ELISAs in einem zentralen Labor. Die Krankheitsaktivität der rheumatoiden Arthritis wurde anhand des Disease Activity Score 28 (DAS28) und des Health Assessment Questionnaire (HAQ) gemessen. Entsprechend ihrer Aktivitätsindizes wurden die Patienten in Subgruppen mit hoher (DAS28>5,1), moderater (3,2<DAS28≤5,1), und niedriger Krankheitsaktivität (2,6≤DAS28≤3,2)sowie Remission (DAS28<2,60) eingeteilt. Die Assoziation zwischen Serum Werten von 25(OH)D und Alter, Krankheitsdauer und Aktivität wurden analysiert.

Ergebnisse: Eine 25-Hydroxyvitamin D Defizienz, ein Mangel und ein suffizienter Spiegel wurden bei 16,00, 4,00 und 80,00% der Kontrollen gefunden, während ein 25(OH)D Mangel und ein suffizienter Spiegel bei 21,80 und 78,20% der rheumatoiden Arthritis Patienten gefunden wurden, was nicht signifikant unterschiedlich in der Gruppenanalyse war (P<0,918). Entsprechend dem DAS28 Score, waren 9,10% der Patienten in Remission (DAS28<2,6), 7,30% hatten eine niedrige Krankheitsaktivität (2,6≤DAS28≤3,2), und 63,60% zeigten eine moderate Aktivität (3,2<DAS28≤5,1) und 20,00% hatten eine hohe Krankheitsaktivität (DAS28>5,1). Die Krankheitsdauer war signifikant länger bei Patienten mit moderater Krankheitsaktivität als bei solchen mit niedriger und hoher Aktivität (P< 0,026 und P<0,001). Die 25(OH)D Werte waren niedriger bei moderater Krankheitsaktivität als bei Patienten in Remission (P<0,014). DAS28 und HAQ waren signifikant höher bei Patienten mit hoher Krankheitsaktivität als in Remission, niedriger oder moderater Krankheitsaktivität. DAS28 und HAQ waren signifikant höher bei Patienten mit moderater Krankheitsaktivität im Vergleich zu Remission und niedriger Krankheitsaktivität. Eine signifikant negative Korrelation zwischen 25(OH)D Werten und der BSG wurde bei Patienten mit rheumatoider Arthritis gefunden.

Schlussfolgerung: Bei Patienten mit rheumatoider Arthritis ist ein Vitamin D Mangel relativ häufig, aber ähnlich häufig wie bei Kontrollpersonen, die Krankheitsaktivität (dargestellt als BSG) ist invers mit den 25(OH)D Werten korreliert.

Key words

vitamin D deficiency - rheumatoid arthritis - disease activity

Schlüsselwörter

Vitamin D Mangel - rheumatoide Arthritis - Krankheitsaktivität

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