Vitamin D Status in Rheumatoid Arthritis Patients
Vitamin D Status in Rheumatoid Arthritis Patients
Background Vitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity. Population-based studies have shown the influence of vitamin D deficiency on quality of life (QoL), but it was not investigated in RA patients.
Objectives The aim of the study was to determine possible relationship between vitamin D deficiency, QoL, physical activity (PA), and disease activity in RA.
Methods In 97 consecutive RA patients without vitamin D supplementation (86 women and 11 men, aged 59.4 ± 12 years), serum 25-hydroxycholecalciferol (25(OH)D), calcium, phosphorus, and parathyroid hormone were measured. The patients completed Short Form 36 (SF-36), Beck Depression Inventory, and Health Assessment Questionnaire, assessed the intensity of pain, fatigue, and PA. Disease Activity Score in 28 Joints was used to assess disease activity. A comparison control group consisted of 28 osteoarthritis patients (25 women and 3 men aged 56.2 ± 15 years).
Results Vitamin D deficiency was detected in 76.3% of RA and in 78.6% of osteoarthritis patients (P = 0.75). There was a negative correlation between 25(OH)D serum concentration and Disease Activity Score in 28 Joints in patients with active arthritis. There was a positive correlation between serum 25(OH)D and the level of PA and most aspects of SF-36, and negative correlation between serum 25(OH)D and Health Assessment Questionnaire and Beck Depression Inventory in patients with disease duration of 1 year or longer. After inclusion of PA into multivariable analysis, only the correlations between 25(OH)D and SF-36 mental subscale (MCS) and pain remained significant.
Conclusions Vitamin D deficiency is highly prevalent in RA patients and is associated with higher disease activity and worse QoL indices. Regular PA correlates with higher vitamin D titers and better QoL in RA. Further studies are needed to explain possible influence of vitamin D on RA activity.
Vitamin D is a steroid hormone precursor, which undergoes 2 hydroxylations, the first converting vitamin D to 25-hydroxyvitamin D (25(OH)D), which is an indicator of vitamin D status, and the second to the main active form, 1,25-dihydroxyvitamin D (1,25(OH)D). Vitamin D deficiency may increase the risk of various autoimmune diseases, including rheumatoid arthritis (RA), and negatively affect RA activity. There are numerous studies linking vitamin D supplementation with improvement of muscle strength and body balance. In addition, many researchers have shown the association between vitamin D deficiency and chronic pain, skeletal muscle weakness, mood disorders, and deterioration of cognitive function in the elderly.
Among the disease-specific questionnaires evaluating the quality of life (QoL) in RA, the most widely used is Health Assessment Questionnaire (HAQ). The world's most widely used generic scale is the Medical Outcome Study Short Form 36 (SF-36). The scale includes 36 questions grouped into 8 domains, which include: general health perception (GH), physical functioning (PF), reduction in performing roles resulting from physical problems (role physical [RP]), reduction in performing roles resulting from emotional problems (role emotional [RE]), social functioning (SF), physical pain (bodily pain [BP]), vitality (VT), and mental health (MH). The results can be presented in the form of a summary of the 2 main domains: physical (PCS) and mental (MCS). Vitamin D deficiency may be associated with worsening of physical and emotional well-being in patients with RA, so we aimed to establish the relationship between serum vitamin D levels and disease activity, physical activity (PA), and quality of life (QoL) in RA patients.
Abstract and Introduction
Abstract
Background Vitamin D deficiency is common in rheumatoid arthritis (RA) and may be related to disease activity. Population-based studies have shown the influence of vitamin D deficiency on quality of life (QoL), but it was not investigated in RA patients.
Objectives The aim of the study was to determine possible relationship between vitamin D deficiency, QoL, physical activity (PA), and disease activity in RA.
Methods In 97 consecutive RA patients without vitamin D supplementation (86 women and 11 men, aged 59.4 ± 12 years), serum 25-hydroxycholecalciferol (25(OH)D), calcium, phosphorus, and parathyroid hormone were measured. The patients completed Short Form 36 (SF-36), Beck Depression Inventory, and Health Assessment Questionnaire, assessed the intensity of pain, fatigue, and PA. Disease Activity Score in 28 Joints was used to assess disease activity. A comparison control group consisted of 28 osteoarthritis patients (25 women and 3 men aged 56.2 ± 15 years).
Results Vitamin D deficiency was detected in 76.3% of RA and in 78.6% of osteoarthritis patients (P = 0.75). There was a negative correlation between 25(OH)D serum concentration and Disease Activity Score in 28 Joints in patients with active arthritis. There was a positive correlation between serum 25(OH)D and the level of PA and most aspects of SF-36, and negative correlation between serum 25(OH)D and Health Assessment Questionnaire and Beck Depression Inventory in patients with disease duration of 1 year or longer. After inclusion of PA into multivariable analysis, only the correlations between 25(OH)D and SF-36 mental subscale (MCS) and pain remained significant.
Conclusions Vitamin D deficiency is highly prevalent in RA patients and is associated with higher disease activity and worse QoL indices. Regular PA correlates with higher vitamin D titers and better QoL in RA. Further studies are needed to explain possible influence of vitamin D on RA activity.
Introduction
Vitamin D is a steroid hormone precursor, which undergoes 2 hydroxylations, the first converting vitamin D to 25-hydroxyvitamin D (25(OH)D), which is an indicator of vitamin D status, and the second to the main active form, 1,25-dihydroxyvitamin D (1,25(OH)D). Vitamin D deficiency may increase the risk of various autoimmune diseases, including rheumatoid arthritis (RA), and negatively affect RA activity. There are numerous studies linking vitamin D supplementation with improvement of muscle strength and body balance. In addition, many researchers have shown the association between vitamin D deficiency and chronic pain, skeletal muscle weakness, mood disorders, and deterioration of cognitive function in the elderly.
Among the disease-specific questionnaires evaluating the quality of life (QoL) in RA, the most widely used is Health Assessment Questionnaire (HAQ). The world's most widely used generic scale is the Medical Outcome Study Short Form 36 (SF-36). The scale includes 36 questions grouped into 8 domains, which include: general health perception (GH), physical functioning (PF), reduction in performing roles resulting from physical problems (role physical [RP]), reduction in performing roles resulting from emotional problems (role emotional [RE]), social functioning (SF), physical pain (bodily pain [BP]), vitality (VT), and mental health (MH). The results can be presented in the form of a summary of the 2 main domains: physical (PCS) and mental (MCS). Vitamin D deficiency may be associated with worsening of physical and emotional well-being in patients with RA, so we aimed to establish the relationship between serum vitamin D levels and disease activity, physical activity (PA), and quality of life (QoL) in RA patients.
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