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Vitamin D and early rheumatoid arthritis

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BMC Rheumatol. 2020 Jul 27;4:38. doi: 10.1186/s41927-020-00134-7. eCollection 2020.

Stephanie R Harrison 1 2, Gurpreet Jutley 3, Danyang Li 1, Ilfita Sahbudin 3, Andrew Filer 3, Martin Hewison 1 4, Karim Raza 2 3

Author Information

1 Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT UK.

2 Department of Rheumatology, Sandwell and West Birmingham NHS Trust, Birmingham, B18 7QH UK.

3 Institute of Inflammation and Ageing, Research into Inflammatory Arthritis Centre Versus Arthritis and MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, B15 2TT UK.

4 Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, B15 2TT UK.

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Abstract

Background: Previous studies have linked rheumatoid arthritis (RA) risk and disease activity with vitamin D-deficiency (low serum 25-hydroxyvitamin D (25OHD)), but a causal role for vitamin D in RA is still unclear, with conflicting results from many previous studies, partly due to heterogeneity in study design and patient populations. In this study we aimed to (1) analyse serum 25OHD in early inflammatory arthritis, (2) compare 25OHD with disease activity and fatigue in early RA and (3) determine whether low 25OHD is associated with progression to RA.

Methods: An analysis of 790 patients recruited to the Birmingham Early Inflammatory Arthritis Cohort and followed longitudinally to determine clinical outcomes. The following were recorded at baseline: demographic data, duration of symptoms, duration of early morning stiffness (EMS), tender and swollen joint counts, Visual Analogue Scale (VAS) pain/fatigue/EMS, PHQ-9, HAQ and FACIT-Fatigue scores, DAS28-ESR, DAS28-CRP, CRP, ESR, anti-CCP antibody status, rheumatoid factor status, and serum 25OHD (ng/ml). Diagnosis was recorded at 0 and 12 months onwards as either RA, Undifferentiated Inflammatory Arthritis (UIA; synovitis not meeting other classification/diagnostic criteria), Clinically Suspect Arthralgia (CSA; arthralgia of an inflammatory type without synovitis), or Other.

Results: Baseline demographic data were similar between all groups, with median symptom duration of 16.8-34.0 days. Baseline 25OHD was not significantly different between groups [median, interquartile range (IQR): RA 46.7, 30.0-73.3; UIA 51.4, 30.0-72.3; CSA 47.7, 30.3-73.0; Other 39.9, 28.6-62.2]. In RA (n = 335), there were no significant differences between 25OHD and measures of disease activity or fatigue. No association between 25OHD and progression from UIA or CSA to RA was observed.

Conclusions: There was no clear association between serum 25OHD and baseline diagnosis, RA disease activity, or progression from UIA or CSA to RA. Future studies of other vitamin D metabolites may better define the complex role of vitamin D in RA.