Experts Urge More Attention to Vitamin D in RA | Arthritis Information

 

Vitamin D is important not only for preventing steroid-induced osteoporosis in rheumatoid arthritis (RA) but also for reducing RA disease activity and risk of falls. Pamela Leventis, MD, and Sanjeev Patel, MD, reviewed studies of vitamin D in RA and suggest in Rheumatology that closer monitoring of vitamin D levels in RA patients to achieve 25(OH) D levels of >8 nmol/L would be a reasonable goal.¹

“Older patients, particularly postmenopausal women, and others at high risk of vitamin D deficiency should be preferentially targeted since they are likely to benefit most from supplementation....The administration of high-dose vitamin D as an oral weekly bolus is safe and can rapidly correct vitamin D deficiency followed by regular lower doses to maintain adequate levels,” Dr. Leventis wrote.

Vitamin D: good not just for bones

The reviewers identified reduced falls and lower RA disease activity as possible benefits of correcting low vitamin D levels in RA patients. “Vitamin D levels reach a peak in autumn and a nadir in spring. There is no evidence for a relationship between season and incidence of RA, season may influence disease activity. A recent large observational study reported higher RA disease activity in spring and lower activity in autumn.” Studies of vitamin D levels in patients with established RA have been mixed, but Dr. Leventis's group has reported “an inverse association between disease activity and vitamin D metabolite concentrations in patients with early polyarthritis,” and a small open-label trial has reported a reduction in RA disease activity with 1,25(OH)2D supplementation.

Patients with low levels of vitamin D also have an increased incidence of falls. Dr. Leventis said that this may be due to effects of vitamin D on muscle function and may be compounded in RA patients by reduced muscle mass and disability. “Vitamin D may reduce falls in these patients due to improvements in muscle strength as well as reduced lower limb joint RA disease activity, although no intervention studies have been performed.”

Vitamin D sufficiency is already a widely-recognized precondition for optimal treatment of the increased risk of osteoporosis and associated fractures seen in patients with RA.

Translating research into practice

“The patient group whom we suggest may benefit most from correction of vitamin D deficiency is older, postmenopausal women with RA. Vitamin D deficiency is very common in this group [who] are at higher risk of falls and fractures by virtue of age and gender. In addition to postmenopausal women, other groups prone to vitamin D deficiency (such as those with little or no sunlight exposure, with nonwhite skin, and individuals with malabsorption) should also be considered,” Dr. Leventis said.

She notes that 25(OH)D levels >80 nmol/L (the level that suppresses parathyroid hormone) may be needed to achieve an immunomodulatory effect in RA patients. A cross-sectional study suggested that an increase in 25(OH)D of about 30 ng/mL (75 nmol/L) would be needed to achieve a 1-point reduction in Disease Activity Score (DAS28). Cholecalciferol (vitamin D3) had generally been more effective than ergocalciferol (vitamin D2) at raising levels of 25(OH)D.

Reference

1. Leventis P and Patel S. Clinical aspects of vitamin D in the management of rheumatoid arthritis [published online ahead of print August 5, 2008]. Rheumatology. 2008. http://rheumatology.oxfordjournals.org/cgi/content/abstract/ken296v1.

Lynn~
I always love your stuff! You're a go getter! I'm a big cheer leader for Vitamin D!!
[QUOTE=anaudlife]
 I'm a big cheer leader for Vitamin D!!
[/QUOTE] Lynn492008-08-29 01:41:59Me three!
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