Abstract
Background: We aimed to provide a systematic review and meta-analysis of randomized controlled trials assessing the effect of oral vitamin supplementation on symptoms and disease activity in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA). Methods: A systematic literature review and meta-analysis of randomized controlled trials including patients with inflammatory rheumatic diseases were performed using MEDLINE, EMBASE and abstracts from recent international rheumatology congresses. Studies were reviewed in accordance with PRISMA guidelines. We analysed clinical outcomes according to each type of vitamin supplementation. Results. The initial search yielded 606 articles. Of these, 13 studies were included in the qualitative synthesis: eight studied vitamin D supplementation, two assessed vitamin E supplementation, two folic acid, and one vitamin K, all of them on RA patients. No studies on SpA or PsA were selected. Oral vitamin supplementations were not associated with a reduction in RA activity (DAS-28 or pain) or RA flares. Conclusions: Despite their beneficial effects, the effects of vitamin supplementation on RA activity, if any, seem to be limited. Evidence on their efficacy on SpA or PsA activity is lacking. However, folic acid supplementation should be suggested to prevent methotrexate-related side effects, and vitamin D should be given to patients with vitamin D deficiency to prevent musculo-skeletal complications.
Highlights
Patients with inflammatory rheumatic diseases (IRD) are seeking natural and safe alternatives to complement their conventional anti-rheumatic therapies
We searched published studies indexed in MEDLINE and EMBASE databases from inception to June 2020 using the search strategy consistent with supplementation in different types of vitamins (A, B, C, D, E and K) and chronic IRD including
The studies fulfilling the following criteria were included into the systematic review: (1) Population: adults with confirmed IRD: rheumatoid arthritis (RA), psoriatic arthritis (PsA) or SpA. (2) Interventions: oral supplementations of vitamin A, B, C, D, E or K. (3) Comparators: placebo, standard of care or no intervention
Summary
Patients with inflammatory rheumatic diseases (IRD) are seeking natural and safe alternatives to complement their conventional anti-rheumatic therapies. Vitamins are over-thecounter supplements which might be attractive for patients as complementary medicines. Its immunomodulatory effects have been known for nearly three decades, and it has been shown that 1,25-dihydroxyvitamin D3 (or calcitriol, the biologically active metabolite of vitamin D) acts via the intracellular vitamin D receptor (VDR). We aimed to provide a systematic review and meta-analysis of randomized controlled trials assessing the effect of oral vitamin supplementation on symptoms and disease activity in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA). Methods: A systematic literature review and meta-analysis of randomized controlled trials including patients with inflammatory rheumatic diseases were performed using MEDLINE, EMBASE and abstracts from recent international rheumatology congresses. 13 studies were included in the qualitative synthesis: eight studied vitamin D supplementation, two assessed vitamin
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