| PHILADELPHIA — Patients with moderately active rheumatoid arthritis had a high prevalence of vitamin D insufficiency and deficiency in a prospective study of 1,160 patients in the Veterans Health Administration system. Based on this finding, the “testing of vitamin D levels is mandatory” in patients with RA, Dr. Gail S. Kerr said at the annual meeting of the American College of Rheumatology. In addition, although “more evidence is needed to determine the exact role of vitamin D in patients with rheumatoid arthritis, we advocate vitamin D replacement as an additional, non-DMARD [disease-modifying antirheumatic drug] component of RA management,” said Dr. Kerr, chief of rheumatology at the Washington D.C. VA Medical Center. The study used patients who were enrolled in the U.S. VARA (Veterans With RA) registry, which began in 2002 at eight VHA centers around the United States. The registry protocol included drawing a blood specimen from patients at the time of their enrollment. Patients entered the registry at similar rates throughout the year, which meant that no seasonal bias skewed their vitamin D levels. The VHA provides medical care to more than 67,000 people with RA. Investigators plan to expand the registry to enroll 12,000 patients eventually. The current analysis focused on the 1,160 enrolled patients for whom vitamin D levels were available. Measurement of serum vitamin D was by a radioimmunoassay. Insufficiency was defined as a level of 30 ng/mL or lower; deficiency was 20 ng/mL or lower. Patients' average age was 64 years; 91% were men, 77% were white, and 17% were black. Their average duration of RA was 12 years, and they generally had moderately active disease. Their average body mass index was 28 kg/m2. Low vitamin D levels were common, with 85% of the patients meeting the definition of insufficiency, and 45% with a deficient level. The average vitamin D level for the entire group was 22 ng/mL. A multivariate analysis showed that patients who were younger and not white, as well as those with higher tender joint counts and higher body mass index, had a higher risk for having vitamin D insufficiency or deficiency. Low vitamin D levels were also significantly linked with being positive for anti–cyclic citrullinated protein antibodies, and with a higher number of comorbidities, Dr. Kerr concluded. http://www.rheumatologynews.com/article/S1541-9800(10)70026-0/fulltext |