Vitamin D Deficiency in Axial Spondyloarthritis is Associated With Higher Disease Activity

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease which predominantly involves the axial skeleton and sacroiliac joints. The aetiology remains unknown but is thought to be immune driven. Vitamin D is a focus for research in numerous autoimmune conditions, especially because it is now thought to have an important role in immunoregulation. It has been hypothesised that low levels of vitamin D increase the risk of autoimmune disease. Considering that vitamin D is implicated in immune regulation and autoimmunity, a question that arises is whether vitamin D deficiency can lead to increased disease activity in axSpA. Through this narrative review of the literature the authors explore potential links between vitamin D and axSpA. This review highlights that larger and more methodologically robust prospective longitudinal studies are required to answer this key question. There was considerable heterogeneity between studies, including in the definition of vitamin D deficiency, latitude where the study took place, and seasonal variation. Another clinically relevant aspect to address is whether correcting vitamin D deficiency leads to improved makers of disease activity in patients with ankylosing spondylitis. This may justify mandatory food fortification and specific supplementation programmes in countries at risk. For example, in Finland there is a low prevalence of vitamin D deficiency in the general population because of food fortification.

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AB0673 SHINING LIGHT ON AXIAL SPONDYLOARTHRITIS: DISEASE ACTIVITY AND VITAMIN D. WHAT’S THE LINK?

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4684 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1631.1-1632

Author(s):

G. A. Brown ◽

K. M. Torsney ◽

E. Nikiphorou

Keyword(s):

Vitamin D ◽

Seasonal Variation ◽

Ankylosing Spondylitis ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Axial Spondyloarthritis ◽

Serum Vitamin ◽

Cross Sectional ◽

Serum Vitamin D ◽

Vitamin D Levels

Background:Axial spondyloarthritis (axSpA) is a chronic inflammatory disease predominantly involving the axial skeleton and sacroiliac joints. Although the exact aetiology remains largely unknown, there is thought to be an immune-driven element. Vitamin D deficiency has been associated with a number of autoimmune diseases and is thought to play an important role in modulating the immune system. Low vitamin D levels may contribute to the development and progression of axSpA1.Objectives:To study the possible associations between low vitamin D and disease activity in axSpA.Methods:A systematic literature search using Medline, Embase and Cochrane was performed using MESH search terms “ankylosing spondylitis”, “axial spondyloarthropathy” and “vitamin D”. Articles examining disease activity measured by BASDAI, ASDAS-CRP, ESR and CRP identified through title/abstract screening, were included in the study, with relevant information extracted.Results:Out of 495 articles identified from the initial search, 19 observational studies which were mostly (89%) cross-sectional studies were identified. There was considerable heterogeneity between studies, including in the definition of vitamin D deficiency, latitude where study took place and seasonal variation. Vitamin D levels were often lower in patients with axSpA compared to controls. Seventeen studies found no association with vitamin D deficiency and disease activity. The exceptions included one study which measured serum vitamin D receptor levels as opposed to serum 25 (OH) D or 1,25 (OH)2 D concentrations, and another study whose recruitment occurred over four years and therefore seasonal variation may conflict results. Patients taking NSAIDs or anti-TNF had no difference in vitamin D levels.Conclusion:Vitamin D deficiency is more prevalent in axSpA but does not seem to associate with increased disease activity. Longitudinal studies are required to better define these links.References:[1]Sizheng Z, et al. Systematic review of association between vitamin D levels and susceptibility and disease activity of ankylosing spondylitis. Rheumatology 2014; 53:1595-1603.Disclosure of Interests:None declared

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Faculty Opinions recommendation of Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.8633956.9137054 ◽

2011 ◽

Author(s):

Zoltán Szekanecz

Keyword(s):

Rheumatoid Arthritis ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency

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Association between vitamin D deficiency and disease activity in Paraguayan patients with systemic lupus erythematosus

Revista Colombiana de Reumatología ◽

10.1016/j.rcreu.2020.12.010 ◽

2021 ◽

Author(s):

Isabel Acosta-Colman ◽

Zoilo Morel ◽

Astrid Paats ◽

Nelson Ortíz ◽

Lourdes Román ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Systemic Lupus

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Rate of hypovitaminosis D and association of plasma concentration of 25(OH)D with indicators of disease activity in patients with rheumatoid arthritis

Doklady of the National Academy of Sciences of Belarus ◽

10.29235/1561-8323-2020-64-6-723-729 ◽

2020 ◽

Vol 64 (6) ◽

pp. 723-729

Author(s):

A. V. Rudenko ◽

T. D. Tyabut ◽

A. E. Buglova ◽

G. A. Babak ◽

P. M. Morozik ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Activity Index ◽

Serum Vitamin ◽

Disease Activity Index ◽

Tender Joint Count ◽

Serum Vitamin D ◽

Vitamin D Levels

Vitamin D deficiency is an important environmental risk factor that influences the prevalence and severity of several autoimmune diseases, including rheumatoid arthritis (RA). The aim of this study was to determine the incidence of vitamin D insufficiency and deficiency in patients with RA, to establish the relationship between serum vitamin D levels and indicators of disease activity. 156 patients with RA were included in the study, mean age 60.2 ± 13.9 years. Assessment of clinical status was performed, serum concentrations of rheumatoid factor (RF), C-reactive protein (CRP), total vitamin D (25(OH)D), antibodies to cyclic citrullinated peptide (ACCP) were determined. RA disease activity was evaluated using DAS28 (disease activity score), SDAI (Simplified Disease Activity Index) и CDAI (Clinical Disease Activity Index) scores. Average levels of 25(OH)D in the surveyed sample were 25.2 ± 13.2 ng/ml. The results of the study indicate a high prevalence of vitamin D deficiency in patients with RA. Normal indicators of vitamin D, its insufficiency and deficiency were observed in 47 (30.3 %), 45 (28.7 %) and 64 (40.7 %) patients, respectively. Low level of serum 25(OH)D was associated with higher indices of RA activity according to DAS28, SDAI and CDAI, as well as with greater tender joint count. Vitamin D should be prescribed as an adjunctive therapy in patients with active RA due to its potential immunomodulatory effect, as well as for the prevention and treatment of bone metabolism disorders.

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AB0789 Vitamin D Deficiency and Disease Activity/Severity in Spondyloarthritis: Results of the ASAS-COMOSPA International Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.2768 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 1163.1-1163

Author(s):

S. Fernandes ◽

A. Etcheto ◽

D. van der Heijde ◽

R. Landewé ◽

F. van den Bosch ◽

...

Keyword(s):

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

International Study

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Vitamin D Status in Patients Operated for Primary Hyperparathyroidism: Comparison of Patients from Southern and Northern Europe

International Journal of Endocrinology ◽

10.1155/2013/164939 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

Erik Nordenström ◽

Antonio Sitges-Serra ◽

Joan J. Sancho ◽

Mark Thier ◽

Martin Almquist

Keyword(s):

Vitamin D ◽

Primary Hyperparathyroidism ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Urinary Calcium ◽

Vitamin D Status ◽

Mineral Density ◽

Before And After ◽

25 Hydroxy Vitamin D ◽

One Year

Aim. The interaction between vitamin D deficiency and primary hyperparathyroidism (PHPT) is not fully understood. The aim of this study was to investigate whether patients with PHPT from Spain and Sweden differed in vitamin D status and PHPT disease activity before and after surgery.Methods. We compared two cohorts of postmenopausal women from Spain(n=126)and Sweden(n=128)that had first-time surgery for sporadic, uniglandular PHPT. Biochemical variables reflecting bone metabolism and disease activity, including levels of 25-hydroxy vitamin D3(25(OH)D) and bone mineral density, BMD, were measured pre- and one year postoperatively.Results. Median preoperative 25(OH)D levels were lower, and adenoma weight, PTH, and urinary calcium levels were higher in the Spanish cohort. The Spanish patients had higher preoperative levels of PTH (13.5 versus 11.0 pmol/L,P<0.001), urinary calcium (7.3 versus 4.1 mmol/L,P<0.001), and heavier adenomas (620 versus 500 g,P<0.001). The mean increase in BMD was higher in patients from Spain and in patients with vitamin D deficiency one year after surgery.Conclusion. Postmenopasual women with PHPT from Spain had a more advanced disease and lower vitamin 25(OH)D levels. Improvement in bone density one year after surgery was higher in patients with preoperative vitamin D deficiency.

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