Abstract
To detect the prevalence of 25-hydroxyvitamin D3 [25(OH)D3] deficiency in rheumatoid arthritis (RA) patients and its correlation with disease activity, functional disability and bone mineral density (BMD). Cross-sectional case control study included 104 RA patients and 60 matched controls. All patients were subjected to full history taking, clinical examination and routine laboratory investigations in addition to measurements of serum 25(OH)D3. Disease activity was assessed by 28-Disease Activity Score (DAS-28) with three variables; tender and swollen 28-joints (T-28 and S-28) and erythrocyte sedimentation rate (ESR). Functional disability was assessed by Modified Health Assessment Questionnaire (M-HAQ). BMD was measured by dual energy x-ray absorptiometry. 25(OH)D3 deficiency was similar in both RA patients and controls (99.1% versus 100%). Although, the mean serum 25(OH)D3 level was less among RA patients than among controls but there was no statistical significant difference (5.98 ± 6.8 nmol/l versus 8.4 ± 9.6 nmol/l, p = 0.06). There were statistically significant correlations between 25(OH)D3 and body weight (r = –0.256, p < 0.009), T-28 (r = –0.559, p < 0.001 ), S-28 (r = –0.631, p < 0.001), DAS-28 (p < 0.001), M-HAQ (p < 0.001) scores, ESR (r = –0.39, p < 0.001) and hemoglobin (r = 0.28, p = 0.004). No significant correlation was found between 25(OH)D3 level and BMD or drug intake. Although the prevalence of 25(OH)D3 deficiency is similar in both RA patients and controls but its deficiency is significantly correlated with increased disease activity and disability but not with BMD.
Highlights
Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology [1]
Conclusion the prevalence of 25(OH)D3 deficiency is similar in both RA patients and controls but its deficiency is significantly correlated with increased disease activity and disability but not with bone mineral density (BMD)
Vitamin D deficiency has been linked to an increased susceptibility to develop autoimmune diseases such as RA [9], systemic lupus erythematosus, multiple sclerosis, and type-1 diabetes in large population studies [10,11]
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disease of unknown etiology [1]. It is characterized by synovitis, cartilage damage, and bone resorption, resulting in structural damage and significant morbidity and mortality [2]. Vitamin D is a steroid hormone synthesized in the skin by the action of ultraviolet irradiation [4]. It plays a major role in the maintenance of proper bone metabolism [5] because it regulates calcium absorption from the gastrointestinal tract [6]. The exact mechanism for the inverse relationship between low vitamin D level and increased inflammatory disease activity is still under investigation [12,13,14]
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