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Egyptian Rheumatology and Rehabilitation
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Relationship between serum 25-hydroxy vitamin D levels, knee pain, radiological osteoarthritis, and the Western Ontario and McMaster Universities Osteoarthritis Index in patients with primary osteoarthritis

Egyptian Rheumatology and Rehabilitation volume 41, pages 66–70 (2014)Cite this article

Abstract

Objective

This study aims to detect the relationship between serum 25-hydroxy vitamin D(25-OHD) levels in patients with primary osteoarthritis (OA) of the knees and with other disease parameters of OA, mainly radiological findings, functional assessment using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and pain [numerical rating scale (NRS)].

Patients and methods

We studied 140 consecutive patients with primary knee OA, 110 female patients and 30 male patients. They were clinically, radiologically, and also functionally evaluated regarding OA; pain was also assessed using NRS, and serum 25-OHD, serum parathormone, serum calcium, phosphorus, and alkaline phosphatase were measured.

Results

In our patient sample, we found that 90 (64.3%) patients had lower 25-OHD levels. The mean serum 25-OHD was 35.77 ± 14.6 (range 10.62–71.82) ng/ml; 25-OHD was negatively significantly correlated with patients’ age (P = 0.013, r= −0.236), radiological degree of OA (P = 0.036, r= −0.20), WOMAC (P < 0.0001, r= −0.337), and NRS for pain (P < 0.0001, r = −0.580). When comparing between patients with hypovitaminosis, 25-OHD less than 40 ng/ml, and patients with desirable 25-OHD levels, we found that radiographic grading of OA was significantly higher in the hypovitaminosis group (t = 2.024, P= 0.045); WOMAC was also significantly higher in the hypovitaminosis group (t = 3.226, P= 0.002) and NRS was also higher in the hypovitaminosis group (t = 4.468, P < 0.0001).

Conclusion

25-OHD deficiency is prevalent in our patients suffering from OA; in addition, 25-OHD may play a role in patients suffering from OA.

References

  1. Buckwalter JA, Martin JA. Osteoarthritis. Adv Drug Deliv Rev 2006; 58:150–167.

    Article  CAS  Google Scholar 

  2. Woolf AD, Pfleger B. Burden of major musculoskeletal conditions. Bull World Health Organ 2003; 81:646–656.

    PubMed  PubMed Central  Google Scholar 

  3. Stoddard SF, Jans L, Ripple J, Kraus L. Chartbook on work and disability in the United States. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research; 1998.

    Google Scholar 

  4. Buckwalter JA, Saltzman C, Brown T. The impact of osteoarthritis: implications for research. Clin Orthop Relat Res 2004; 427:S6–S15.

    Article  Google Scholar 

  5. Andriacchi TP, Koo S, Scanlan SF. Gait mechanics influence healthy cartilage morphology and osteoarthritis of the knee. J Bone Joint Surg Am 2009; 91:95–101.

    Article  Google Scholar 

  6. Jordan KM, Arden NK, Doherty M, Bannwarth B, Bijlsma JW, Dieppe P, et al. EULAR Recommendations 2003: An Evidence Based Approach to the Management of Knee Osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis 2003; 62:1145–1155.

    Article  CAS  Google Scholar 

  7. Muraki S, Akune T, Oka H, En-Yo Y, Yoshida M, Nakamura K, Kawaguchi H, and Yoshimura N. Prevalence of radiographic knee osteoarthritis and its association with knee pain in the elderly of Japanese population-based cohorts: the ROAD study. Osteoarthritis Cartilage 2009; 17:1137e43.

    Article  Google Scholar 

  8. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in the general population: the Chingford study. J Rheumatol 1993; 20:331–335.

    PubMed  CAS  Google Scholar 

  9. Roos H, Adalberth T, Dahlberg L, Lohmander LS. Osteoarthritis of the knee after injury to the anterior cruciate ligament or meniscus: the influence of time and age. Osteoarthritis Cartilage 1995; 3:261–267.

    Article  CAS  Google Scholar 

  10. Muraki S, Akune T, Oka H, Mabuchi A, En-Yo Y, Yoshida M, et al. Association of occupational activity with radiographic knee osteoarthritis and lumbar spondylosis in elderly patients of population-based cohorts: a large-scale population-based study. Arthritis Rheum 2009; 61:779e86.

    Article  Google Scholar 

  11. Hart DJ, Doyle DV, Spector TD. Association between metabolic factors and knee osteoarthritis in women: the Chingford Study. J Rheumatol 1995; 22:1118–1123.

    PubMed  CAS  Google Scholar 

  12. Spector TD, Cicuttini F, Baker J, Loughlin J, Hart D. Genetic influences on osteoarthritis in females: a study of twins. BMJ 1996; 312:940–943.

    Article  CAS  Google Scholar 

  13. Atherton K, D J Berry, T Parsons, G J Macfarlane, C Power, and Hypponen E. Vitamin D and chronic widespread pain in a white middle-aged British population: evidence from a cross-sectional population survey Ann Rheum Dis 2009; 68:817–822

  14. Poole A. Imbalances of anabolism and catabolism of cartilage matrix components in osteoarthritis. In: Kuettner KE, Goldberg VM, editors. Osteoarthritic disorders. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1995. pp. 247–260.

    Google Scholar 

  15. Corvol MT, Dumontier MF, Tsagris L, Lang F, Bourguignon J. Cartilage and vitamin D in vitro. Ann Endocrinol (Paris) 1981; 142:482–487.

    Google Scholar 

  16. Lacraz S, Dayer JM, Nicod L, Welgus HG. 1,25-Dihydroxy vitamin D3 dissociates production of interstitial collagenase and 92-kDa gelatinase in human mononuclear phagocytes. J Biol Chem 1994; 269:6485–6490.

    PubMed  CAS  Google Scholar 

  17. McAlindon TE, Felson DT, Zhang Y, Hannan MT, Aliabadi P, Weissman B, et al. Relation of dietary intake and serum levels of vitamin D to progression of osteoarthritis of the knee among participants in the Framingham Study. Ann Intern Med 1996; 125:353e9.

    Article  Google Scholar 

  18. Hunter DJ, Hart D, Snieder H, Bettica P, Swaminathan R and Spector TD. Evidence of altered bone turnover, vitamin D and calcium regulation with knee osteoarthritis in female twins. Rheumatology (Oxford) 2003; 42:1311e6.

    Google Scholar 

  19. Felson DT, Niu J, Clancy M, Aliabadi P, Sack B, Guermazi A, et al. Low levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum 2007; 56:129e36.

    Google Scholar 

  20. Bergink AP, Uitterlinden AG, Van Leeuwen JP, Buurman CJ, Hofman A, Verhaar JA, and Pols HA. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: the Rotterdam Study. J Clin Rheumatol 2009; 15:230e7.

    Article  Google Scholar 

  21. Ding C, Cicuttini F, Parameswaran V, Burgess J, Quinn S. Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults Arthritis Rheum 2009; 60:1381–1389.

    Google Scholar 

  22. Heidari B, Heidari P, Hajian-Tilaki K. Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop 2010; 35:1627–1631.

    Article  Google Scholar 

  23. Al-Jarallah KF, Shehab D, Al-Awadhi A, Nahar I, Haider MZ, and Moussa MA. Are 25(OH)D Levels Related to the Severity of Knee Osteoarthritis and Function? Med Princ Pract 2012; 21:74–78.

    Article  Google Scholar 

  24. Altman R, Asch E, Bloch D, Boil G, Borestein D, Brandt K, et al. Development of criteria for classification and reporting of osteoarthritis of the knee. Arthritis Rheum 1986; 29:1039–1049.

    Article  CAS  Google Scholar 

  25. Kellgren JH, Lawrence JS, editors. The epidemiology of chronic rheumatism: atlas of standard radiographs of arthritis. Oxford: Blackwell Scientific; 1963.

    Google Scholar 

  26. Altman R. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthritis Cartilage 2007; 15:A1–A56.

    Article  Google Scholar 

  27. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 1988; 15:1833–1840.

    CAS  Google Scholar 

  28. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P and Goldsmith CH. Reliability of pain scales in the assessment of literate and illiterate patients with rheumatoid arthritis. J Rheumatol 1990; 17:1022–1024.

    PubMed  CAS  Google Scholar 

  29. Alonso GC, Diaz NM, Garcia RM, Fernández Martín JL, Cannata Andía JB. Review of the concept of vitamin D ‘sufficiency and insufficiency’. Nefrologia 2003; 23:73–77.

    Google Scholar 

  30. Wells C. The paleopathology of bone disease. Practitioner 1973; 210: 384–391.

    PubMed  CAS  Google Scholar 

  31. Braunstein EM, White SJ, Russell W, and Harris JE. Paleoradiologic evaluation of the Egyptian royal mummies. Skeletal Radiol 1988; 17:348–352.

    Article  CAS  Google Scholar 

  32. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W and Meenan RF. The prevalence of OA in the elderly. Arthritis and rheumatism 1987; 30:914–918.

    Article  CAS  Google Scholar 

  33. Mithal A, Wahl DA, Bonjour JP, Burckhardt P, Dawson-Hughes B, Eisman JA, et al. Global vitamin D status and determinants of hypovitaminosis D. International Osteoporosis Foundation and National Osteoporosis Foundation 2009, Osteoporos Int. 2009.

  34. Murakiy S, Dennisonz E, Jamesonz K, Boucherx BJ, Akuney T, Yoshimura, et al. Association of vitamin. D status with knee pain and radiographic knee, Osteoarthritis and Cartilage 2011; 19:1301–1306.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Rheumatology and Rehabilitation, Minia University, Minia, Egypt

    Ahmed Lotfi A, Rasha A. Abdel-Magied MD & Rawhya R. El-Shereef

  2. Department of Clinical Pathology, Minia University, Minia, Egypt

    Ahmed A. Saedii

  3. Department of Diagnostic Radiology, Minia University, Minia, Egypt

    Ehab A. AbdelGawad

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  1. Ahmed Lotfi A
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  2. Rasha A. Abdel-Magied MD
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Correspondence to Rasha A. Abdel-Magied MD.

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A, A.L., Abdel-Magied, R.A., El-Shereef, R.R. et al. Relationship between serum 25-hydroxy vitamin D levels, knee pain, radiological osteoarthritis, and the Western Ontario and McMaster Universities Osteoarthritis Index in patients with primary osteoarthritis. Egypt Rheumatol Rehabil 41, 66–70 (2014). https://doi.org/10.4103/1110-161X.132459

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