Vitamin D deficiency confirmed as common across a range of rheumatic conditions

European League Against Rheumatism ^ | June 18, 2010 | Unknown

[decimon]

Recommended supplementation is not sufficient to normalise vitamin D levels in RA and osteoporosis patients

Rome, Italy, Friday 18 June 2010: Two separate studies have shown that vitamin D deficiency is common in patients with a range of rheumatic diseases, with over half of all patients having below the 'normal' healthy levels of vitamin D (48-145 nmol/L) in their bodies. A further study assessing response to vitamin D supplementation found that taking the recommended daily dose did not normalise vitamin D levels in rheumatic disease patients. The results of these three studies were presented today at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy.

A UK study1 of 180 patients aimed to assess mean levels of vitamin D in patients with inflammatory joint diseases, osteoarthritis and myalgia (muscle pain that, when experienced long term may be associated with nutritional deficiency). Data on vitamin D levels were gathered and results showed that 58% of individuals with a rheumatic condition had levels below that clinically considered to be 'sufficient' in healthy subjects (48-145 nmol/L).

An Italian study2 of 1,191 RA patients aimed to determine a correlation between vitamin D deficiency and several different clinical measures of disease activity. Researchers found that, regardless of supplementation, levels of 25-hydroxyvitamin D (25(OH)D), (a standard clinical measure of vitamin D in the blood), were lower than healthy levels (<50 nmol/L) in 85% of the patients not taking a vitamin D supplement and in 60% of those taking 800 IU or more vitamin D daily as a supplement. In non-supplemented patients levels of 25(OH)D significantly correlated with three measures of disease activity - the Health Assessment Questionnaire Disability Index, (p=0.000) the Mobility Activities of Daily Living Score (p=0.000) and the Number of Swollen Joints count (p=0.000).

"We have seen in studies that vitamin D deficiency is common in patients with a range of rheumatic diseases, and our results have confirmed this using several clinically accepted measures of disease activity," said Dr. L. Idolazzi, of the Rheumatology Unit, University of Verona, Italy. "What we need to see now is a range of long term studies, which examine the clinical response of patients to vitamin D supplementation."

Furthermore, a third study undertaken in Italy3 aimed to evaluate the affect of vitamin D supplementation in patients with inflammatory autoimmune disease (IAD) and non-inflammatory autoimmune disease (NIAD). Following supplementation, only 29% patients reached vitamin D levels greater than the level clinically considered to be 'sufficient' in healthy subjects, with no significant differences in vitamin D levels observed between the IAD and NIAD groups.

"Whilst it is well known that hypovitaminosis D is often seen in patients with inflammatory autoimmune diseases, the effects of supplementation have not been fully investigated in this setting," said Dr. Pier Paolo Sainaghi of the Immuno-Rheumatology Clinic, A. Avogadro University of Eastern Piedmont, Novara, Italy and author of the third study. "The results of our study show that daily 800-1,000 IU supplementation is not sufficient to normalise vitamin D levels in patients with rheumatologic or bone conditions. What is unclear is whether a higher dose would be more effective."

Study designs and key statistics

The UK study1 involved patients with a diagnosis of rheumatoid arthritis (RA), osteoporosis, or unexplained muscle pain, (total n=90, 30 from each group). These patients were matched with a control group of patients presenting with chronic back pain for a minimum of 6 months (n=90). The RA patient group registered median levels of vitamin D of 36 nmol/L (range 16-85 nmol/L, p=0.045) and in osteoporosis patients, these levels were slightly lower with a median value of 31 nmol/L (range 7-82 nmol/L, p=0.005). Patients with unexplained muscle pain had equally low median levels of vitamin D at 31 nmol/l (range 11-79 nmol/L, p= 0.008).

In the first Italian study2 of 1,191 patients (85% women) from 22 rheumatology centres, researchers measured levels of 25(OH)D, alongside paramaters of disease activity, calcium intake, sun exposure and bone mineral density. The association found by researchers between disease activity scores and vitamin D levels remained statistically significant when adjusted for both sun exposure and body mass index (BMI), both known risk factors for vitamin D deficiency. Significantly lower 25(OH)D levels were found in patients with active disease compared with those in disease remission (mean level 21.8 nmol/L 25(OH)D vs. 23.6 nmol/L respectively, p=0.057), and in those who were not responding to treatment compared to patients with a good response to treatment (20.5 nmol/L vs. 23.4 nmol/L p=0.020).

In the third Italian study3, 100 patients (43 with IAD and 57 with NIAD) received daily supplementation of 800-1000 IU of cholecalciferol (a form of vitamin D often used to fortify foods) over the course of six months. Abstract Numbers: FRI0509, SAT0093, SAT0506

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For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR congress Press Office on the 1st floor of Hall 5 of the Congress Centre during EULAR 2010 or on: Email: eularpressoffice@uk.cohnwolfe.com

About EULAR

* The European League Against Rheumatism (EULAR) is the organisation which represents the patient, health professional and scientific societies of rheumatology of all the European nations. * In line with The European Union of Medical Specialists (UEMS), EULAR defines rheumatology as including rheumatic diseases of the connective tissue, locomotor and musculoskeletal systems. * The aims of EULAR are to stimulate, promote, and support the research, prevention, treatment and rehabilitation of rheumatic diseases. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with rheumatic diseases. * EULAR 2010 is set to be the biggest rheumatology event in Europe with over 15,000 scientists, physicians, allied health professionals, and related audiences in attendance from over 100 countries. Over the course of the congress, almost 300 oral and more than 1600 poster abstract presentations will be featured, with 300 invited speaker lectures taking place in more than 140 sessions. * To find out more about the activities of EULAR, visit: www.eular.org

[decimon]

Ping

[Fantasywriter]

Does this mean if you’re D deficient you’re more likely to have arthritis?

[Taggart_D]

ping

[decimon]

Does this mean if you’re D deficient you’re more likely to have arthritis?

I don't believe the researchers are clear as to cause or effect. They do see a correlation.

In this case they indicate a desire to test whether increased vitamin D supplementation helps correct RA. Otherwise, I guess, they would have to follow peoples' vitamin D levels for decades to get a good idea if low levels of vitamin D cause RA. And just a good idea because other factors would have to be considered.

IOW, I don't know.

[Fantasywriter]

Thank you. I’m not good at deciphering articles like this (not enough patience?) but that was a very clear and concise answer. I really appreciate it!

[Kimmers]

Please FReepers next time you see your doc request a Vit D drawn.....a friend of mine is an orthopedist and draws a Vit D on all of his patients and has found only one to be sufficient....he now has most docs in the hospital checking Vit D levels...

Yes, it effects the muskoskeletol system but also cardiac, healing a range of bodily functions...

I take 5,0000 IU/day

[exist]

OMG all these articles are making me paranoid.

[Judith Anne]

Before supplementing with Vit D, it’s wise to check the serum calcium. Most people with hypercalcemia don’t discover it except by accident because the symptoms are vague unless the person is dehydrated. Supplementing vit D in the presence of hypercalcemia can raise the calcium to dangerous levels.

Just something it’s wise to check, along with the D levels.

[FlyingFish]

"Does this mean if you’re D deficient you’re more likely to have arthritis?"

Yes, it certainly suggests this, however, we don't know the direction of causality. Is D deficiency driving the autoimmune response or the other way round? They tried to see if increasing D would have an impact, but 800 to 1000 IU seems low by current research findings. Some experts are recommending daily doses in the 5000-10000 range, and even adding some starting booster shots. The recommended intake for pregnant women was just raised 10-fold, from 400IU a day to 4,000IU. The old 400IU RDA was based on very old research that showed this level prevents rickets. As a point of reference, 20 minutes in the sun can produce 10,000IU in the body. Vitamin D, which has almost hormonal like properties in the body, has far reaching impact on many diseases and health. It seems every week, another study shows the power of Vitamin D.

[Ditter]

My doctor checked my Vitamin D at my last checkup and found me to be low normal, I am 70 years old. I take 1000 units per day.

[Aria]

I take 5k a day also.

Not sure if it would affect my oxygen but yesterday I got my BP, oxygen and pulse checked and all were great. Also, I feel great

[decimon]

Good reply but remember that this is in Europe and who knows what is a recommended daily allowance there.

[Fantasywriter]

Wow—thanks for that explanation! Everything you said was VERY interesting and informative. I won’t ask if you’re a dr. You sound like one, but you could just be a very well informed, brilliant person. ;)

[padre35]

There is a level of Vitamin D that can be toxic though:

http://www.vitamindcouncil.org/vitaminDToxicity.shtml

The article from the “Vitamin D Council” (hmm) claims 40k IU’s over time can be toxic.

A better explanation:

https://health.google.com/health/ref/Hypervitaminosis+D

[decimon]

OMG all these articles are making me paranoid.

Good. My evil plot is working. ;-)

[FrdmLvr]

I take 5,000/day, too. I asked my doctor if he would check my Vit D levels years ago and he said he wouldn't so I just started taking it on my own. Now that Vit D deficiency is becoming more recognized as a health issue, he probably would.

It's important to take Vitamin D3, not just Vitamin D.

[SharpRightTurn]

“the ‘normal’ healthy levels of vitamin D (48-145 nmol/L) in their bodies.”

I used to go to a Doc. who didn’t have a clue about nutrition and supplements. I didn’t stay with him long.

My current Doc. keeps up on the research. He regularly draws blood; the last analysis of my Vit. D level showed me to be in the low 40s. He recommended increasing my intake of Vit. D from 5,000 IU to 8,000 IU. He wants it above 50.

Every week I see a new study on the benefits of keeping Vit. D levels in the optimal range.

[Calm_Cool_and_Elected]

I’ve had some problems with low vitamin D and I also have an auto-immune disease. I see my Dr for a checkup next month, she will test for celiac just to be sure but I think it lack of exposure. My disease also has a skin rash so I stay out of the sun whenever possible.

[tutstar]

do u ping on this topic?