Background/Purpose: Vitamin D (D25) deficiency has been an ongoing matter of concern, especially in countries at northern latitudes. The effects of D25 deficiency in patients with chronic musculoskeletal conditions could be pronounced resulting in greater disability¹.Despite this, D25 deficiency does not always represent a priority treatment in rheumatology clinics.

Methods: Register-based, cross-sectional study of adult patients (n=5857) seen in an outpatient rheumatology clinic. Calcium & D25 supplementation has been advised and prescribed routinely in this clinic for over 20 years at the first clinic review & without measuring D25 levels, especially in patients on steroids. Patients with suspected rheumatic diseases have their demographic, laboratory, clinical & patient-reported outcomes (PROs) e.g. physical status, fatigue recorded on an electronic tool as part of the normal infra-structure of the clinic. D25 is measured & recorded at baseline as part of routine care & as indicated at follow-up visits in Jan2011-Apr2015. Deficiency is defined as D25 level <50 nmol/l, severe deficiency <20; insufficiency 50-75; optimal levels >75; toxic levels >275. Statistical analysis included uni/multivariate regression models adjusting for age/gender; Spearman’s correlation testing, significance assumed at 0.01(2-tailed).

Results: D25 was measured in 3203 (55%) patients (mean age 54; 68% female). Diagnoses included:RA (n=1386), unspecified arthralgia/myalgia (n=400), spondyloarthropathy (192) & psoriatic arthritis (n=138). The overall D25 mean (SD) level was 78 (31), median (IQR) 75 (55, 97). 17.8% had D25 deficiency (8.4% less than 40), only 0.7% severe (<20nmol/l). No patient had toxicity.The highest proportion of D25 deficiency was seen in patients with non-specific arthralgia/myalgia, psoriatic arthritis & fibromyalgia (>20% ).The lowest mean level (66) at first visit was seen for the sarcoidosis group, highest (91) for SLE/Sjogren. Among 29 patients with darker skin, 48% had D25 deficiency, while only 8.1% among 3174 patients of Northern European origin were deficient. D25 levels were higher in women vs men, mean 79 vs 76 (p=0.044) & non-smokers vs smokers, mean 78 vs 75 (P=.005). D25 levels correlated with longer follow up in the clinic (Sp.Rho 0.101, P<.001). Higher D25 levels correlated with older age (Sp.Rho 0.205,P<.001), lower BMI (Sp.Rho -0.206, P<.001), more physical exercise (Sp.Rho 0.091, P<.001) & lower education (Sp.Rho -0.049, P=.017). None of the PROs correlated significantly with D25 levels. In multivariate analysis, younger age, non-white background, higher BMI & less frequent exercise significantly predicted D25 deficiency.Patients of non-white background were 5.4 times more likely to have D25 deficiency compared to those of white background.

Conclusion: The proportion of patients with D25 deficiency was low, supporting active calcium/D25 supplementation and patient education as an effective strategy for actively preventing D-25 deficiency. Risk groups identified included patients of non-white background, less physical exercise and higher BMI, the latter two possibly representing surrogates of less healthy lifestyle.

1.Haque UJ, Bartlett SJ. Clin Exp Rheumatol. 2010;28:745-747.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/vitamin-d-deficiency-states-can-be-actively-prevented-results-from-a-cross-sectional-study-of-over-3000-patients-with-rheumatic-diseases/