Vitamin D Changes the Tide in Rheumatoid Arthritis

Severe vitamin D deficiency could be responsible for persistent rheumatoid arthritis disease activity, according to a new study.  The goal of this study was to assess the relationship between vitamin D deficiency and active rheumatoid arthritis, and the role of supplements in improving disease activity. Vitamin D deficiency has been linked to immune disorders, including rheumatoid arthitis, but how much vitamin D is enough, has been a bit of a controversy.

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The researchers found that supplementation of vitamin D in rheumatoid arthritis patients with persisting disease activity and vitamin D deficiency, contributed to significant improvements in disease activity within a short duration. The

findings

appear in the Oct. 20 issue of

The International Journal of Rheumatic Diseases

.  The study was conducted with 149 patients with active rheumatoid arthritis. Researchers observed the impact of vitamin D supplementation on illness duration, pain severity, tender joint counts, swollen joint counts, serum vitamin D levels, erythrocyte sedimentation rate and C-reactive protein. The mean participant age at recruitment was 49, with 94% being female and 6% being male. The average duration of illness was 78 months, and average length of disease-modifying anti-rheumatic drugs treatment was 44 months. Participants also had other co-morbid conditions, including diabetes, hypothyroidism, asthma, and benign prostatic hyperplasia.  Patients were divided into four groups: 1. high disease activity with low vitamin D2. high disease activity with normal vitamin D3. low disease activity with low vitamin D4. low disease activity with normal vitamin D Group 1 exhibited the greatest degree of vitamin D deficiency. These participants had a disease activity score of 28 joints-CRP (DAS28-CRP) of >2.6 and a serum vitamin D level of 20 ng/mL. They were recruited into open-label vitamin D supplementation of 60,000 IU once a week for six weeks. They tapered down to the same amount once a month for three months. Researchers reassessed participants at the end of the three months for erythrocyte sedimentation rate, C-reactive protein and vitamin D levels. After three months, 59 patients were re-evaluated, and results showed an improvement in disease activity for more than 50% of patients. Mean DAS28-CRP showed a statistical improvement from 3.68 +/- 0.93 to 3.08 +/- 1.11 after supplementation. Serum blood levels also improved from 10.05 +/- 5.18 to 57.21 +/- 24.77 ng/mL during the same timeframe.  Data showed no significant improvement or change in erythrocyte sedimentation rate and C-reactive protein levels, likely due to small population sampling, but statistically significant changes emerged in joint count and pain scale measures. Additionally, findings showed vitamin D may improve patients’ pain perception (pain threshold), impacting TJC. Researchers noted the small patient population available for screening could be a limiting factor – more participants could be needed to show real differences in the impact of vitamin D on various stages of active rheumatoid arthritis. In addition, they concluded, it is possible the impact of vitamin D on inflammation is trivial. 

References:

Chandrashekara S, Patted A. 

"Role of vitamin D supplementation in improving disease activity in rheumatoid arthritis: An exploratory study," 

Int J Rheum Dis. 2015 Oct 20. doi: 10.1111/1756-185X.12770. [Epub ahead of print].