Abstract
The objective of this study is to examine 25-hydroxyvitamin D [25(OH)D] (D-25) levels and associations with patient- and disease-related factors in rheumatic diseases. This is a register-based study of D-25 levels in adult patients seen at the Central Finland Hospital rheumatology clinic (January 2011–April 2015). Demographic, clinical, laboratory, and patient-reported outcomes (PROs) were collected as part of the normal infrastructure of the outpatient clinic and examined for their association with D-25 level. Statistical analysis included descriptive statistics and univariable and multivariable regression analyses adjusting for age and gender. D-25 was measured in 3203 patients (age range 15–91 years, mean 54; 68% female) with diagnoses including RA (n = 1386), unspecified arthralgia/myalgia (n = 413), and connective tissues diseases (n = 213). The overall D-25 mean (SD) level was 78 (31) and median (IQR) 75 (55, 97). At baseline, 17.8% had D-25 deficiency, and only 1.6% severe deficiency (< 25 nmol/l); 34%/49% had sufficient/optimal D-25 levels. Higher D-25 levels were associated with older age, lower BMI, and regular exercise (all p < 0.001) among other factors. In multivariable analyses, younger age, non-white background, higher BMI, smoking, less frequent exercise (p < 0.001), and first visit to the clinic (p = 0.033) remained significantly associated with D-25 deficiency. Among those with sub-optimal D-25 levels, 64% had improved to sufficient/optimal levels after a median (IQR) of 13 (7.8, 22) months. The proportion of patients with D-25 deficiency in this study was generally low. Older patients had considerably higher D-25 levels compared to younger patients. Lower physical exercise and higher BMI were associated with higher risk of deficiency. The study supports the benefit of strategies to help minimize the risk of D-25 deficiency.
Highlights
Vitamin D (D-25) deficiency has represented a growing concern over the years, with a recognized higher risk at northern latitudes and in winter and spring seasons [1, 2]
A total of 3203 patients seen at Jyvaskyla Central Hospital rheumatology clinic between January 2011 and April 2015 had their D [25(OH)D] (D-25) levels measured
One third of the patients had D-25 re-measured after a median (IQR) of 13 (7.8, 22) months
Summary
Vitamin D (D-25) deficiency has represented a growing concern over the years, with a recognized higher risk at northern latitudes and in winter and spring seasons [1, 2]. Reports on the re-emergence of rickets in Europe in the twenty-first century [3–6] have further strengthened concerns around the persistence of D-25 deficiency states and resulted in a number of mandatory food fortification and specific supplementation programs in various countries at risk. Epidemiological data suggest that D-25 deficiency may be a risk for the development of autoimmune, chronic diseases [2, 7] including RA [8–10]. D-25 deficiency has been associated with non-specific musculoskeletal pain in acute rehabilitation unit patients [12]. Despite evidence supporting the pronounced effects of D25 deficiency in patients with known chronic musculoskeletal conditions, it does not always represent a priority treatment at all rheumatology clinics. A previous study [8] reported low D-25 levels to be an independent predictor of greater disability in patients with RA, but patient numbers were small and based on academic-setting rheumatology clinics
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