Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Osteoporosis and cardiovascular disease are complications of chronic rheumatoid arthritis (RA). It is not known if these processes share pathogenetic mechanisms. Low levels of vitamin D predispose to bone fragility. Recent data suggest that they may also be linked to vascular disease.
Methods:
A cross-sectional study of RA patients and age-/sex-matched controls was carried out. None had any history of cardiovascular disease or diabetes mellitus. Levels of 25-hydroxy vitamin D were recorded and DXA scans were performed. Evidence of sub-clinical atherosclerosis was obtained with pulse wave analysis (PWA) and carotid intimal-medial thickness (CIMT). Serum markers of vascular disease (ICAM1, oxidized LDL, HSP60, IL6), a lipid profile and body mass index (BMI) were measured. Early RA was defined as those with disease duration less than 2 years. Data were analysed using SPSS 16.0.
Results:
99 people were included in this study (74 RA and 25 controls). Fifty-two (70%) of the RA group and 8 (31%) of the control group were taking calcium / vitamin D supplements (average vitamin D level 400iu/day). Only 12 (13%) had normal vitamin D levels (>80nmol/l). Vitamin D levels were deficient (<25nmol/l) in 21% and insufficient (>25 <80nmol/l) in 65%. All patients with early RA were vitamin D deplete (n = 18); 33% had insufficient levels and 67% deficient amounts. In contrast, 20% (n = 11) of those with established RA had normal vitamin D levels, while 65% had insufficient and 15% deficient levels. Mean vitamin D measurements were 38.5nmol/l in early RA versus 58nmol/l in established RA (p = 0.02).
Bone mineral density was similar between RA and controls. In the RA cohort, 29% had evidence of osteoporosis, while 46% had osteopenia and 25% had a normal DXA scan. In those with early RA, osteoporosis was present in 3 (18%) versus 16 (32%) patients with chronic RA (p = 0.3)
In RA, there was a negative correlation between vitamin D levels and DXA T-scores (p = 0.02), and BMI (p = 0.007). While RA patients had significantly greater levels of serum markers of vascular disease (IL6, ICAM1, oxidized LDL, HSP60) compared with controls, there was no correlation with vitamin D levels. CIMT measurements correlated negatively with vitamin D. (p=0.06). Using multiple linear regression controlling for age, CIMT and DXA T-scores, and calcium/vitamin D supplements, vitamin D levels were negatively correlated with PWV (p=0.04), across the entire study group. Triglyceride levels were inversely related to vitamin D across the study group (cc -0.3, p<0.01).
Conclusion:
Low levels of vitamin D were common in this population, particularly in those with early RA. Vitamin D supplementation at current dosages does not achieve normal vitamin D levels. The association between low vitamin D levels and markers of both osteoporosis and atherosclerosis needs to be further explored. In particular, a lack of sunlight in relation to insufficient exercise exposure may be relevant in exploring this link.
Disclosure:
B. J. Sheane,
None;
R. Dunne,
None;
K. Scott,
None;
M. Hall,
None;
M. O’Connor,
None;
M. Healy,
None;
J. Feely,
None;
J. B. Walsh,
None;
G. Cunnane,
None.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/association-between-low-vitamin-d-levels-and-indicators-of-osteoporosis-and-atherosclerosis/