Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Vitamin D deficiency is highly common in patients with rheumatoid arthritis (RA) (1). In vitro, vitamin D has anti-inflammatory effects and vitamin D has been linked to disease activity in RA due to its immuno-modulatory properties (1,2). The aim of this study is to investigate the association between vitamin D status and disease activity in newly diagnosed RA patients before start of therapy.
Methods: Consecutive patients with active, newly diagnosed RA (symptom duration <2 years), were randomized for treatment with COBRA or COBRA-light therapy (3). Before start of therapy, baseline values were determined, including Disease Activity Score (44 joints; DAS) and serum 25-hydroxy vitamin D (25(OH)D) levels. Based on the widely used cutoff values, patients were stratified into three groups based on baseline serum 25(OH)D levels: <50 nmol/l, 50-74 nmol/l, and ≥75 nmol/l.
Results: Baseline serum 25(OH)D levels were determined in 147 of 164 included RA patients in the COBRA-light trial (90% of trial population). Serum 25(OH)D levels of the different groups are presented in Table 1. Patients with a baseline serum 25(OH)D level ≥75 nmol/l had a significant lower mean DAS compared to patients with a baseline serum 25(OH)D <75 nmol/l (p=0.001). Vitamin D deficient patients (<50 nmol/l) had a significant shorter symptom duration (p=0.003), and were more often rheumatoid factor positive (p=0.015) compared to patients with sufficient serum 25(OH)D levels.
Table 1. Vitamin D status and disease related factors of patients with newly diagnosed rheumatoid arthritis before start of therapy
|
|
Serum 25(OH)D <50 nmol/l (n=62; 42%) |
Serum 25(OH)D 50-74 nmol/l (n=50; 34%) |
Serum 25(OH)D ≥75 nmol/l (n=35; 24%) |
|
Disease Activity Score (DAS, 44 joints) |
4.2 (0.7) |
4.0 (0.9) |
3.6 (0.7)* |
|
Symptom duration (weeks) |
12 [8,21]* |
18 [8,49] |
25 [13,36] |
|
Health Assessment Questionnaire Score (HAQ, 0 to 3) |
1.5 (0.8) |
1.3 (0.6) |
1.2 (0.6) |
|
Serum 25(OH)D (nmol/l) |
36 [25,46] |
61 [54,67] |
87 [81,100] |
|
Rheumatoid factor positive (n(%)) |
44 (72)† |
22 (45) |
20 (57) |
|
aCCP positive (n(%)) |
44 (71) |
26 (53) |
25 (71) |
Values are reported as mean (SD) or median [IQR], unless otherwise specified; * Differs significantly from both other groups (p-value<0.05); † Differs significantly from serum 50-74 nmol/l (p-value<0.05); 25(OH)D: 25-hydroxy vitamin D; aCCP: antibodies against cyclic citrullinated peptides.
Conclusion: Newly diagnosed RA patients with serum 25(OH)D levels ≥75 nmol/l demonstrate a significant lower disease activity than patients with a serum 25(OH)D level <75 nmol/l before start of therapy. This study cannot distinguish whether a lower DAS at baseline is caused by immuno-modulatory properties due to higher serum 25(OH)D levels, or that higher serum 25(OH)D levels are caused by more frequent outdoor activities related to a lower DAS. Since 75% of the newly diagnosed RA patients have insufficient serum 25(OH)D levels (<75 nmol/l), vitamin D supplementation should be considered in every newly diagnosed RA patient.
References: (1) Grazio S, et al. Am J Med Sci 2014; (2) Baker JF, et al. Clin Exp Rheumatol 2012; (3) Den Uyl D, et al. Ann Rheum Dis 2013.
To cite this abstract in AMA style:
Rasch L, Konijn N, Krul-Poel Y, van Tuyl L, Raterman H, ter Wee M, den Uyl D, Simsek S, Nurmohamed M, Lems W. High Levels of 25(OH)D Are Associated with Lower Disease Activity in Patients with Newly Diagnosed Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/high-levels-of-25ohd-are-associated-with-lower-disease-activity-in-patients-with-newly-diagnosed-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/high-levels-of-25ohd-are-associated-with-lower-disease-activity-in-patients-with-newly-diagnosed-rheumatoid-arthritis/