Skip to main content
Egyptian Rheumatology and Rehabilitation
Download PDF
  • Original article
  • Open access
  • Published:

Prevalence of vitamin D deficiency in Egyptian rheumatoid arthritis patients: correlation with disease activity, functional disability, and bone mineral density

Egyptian Rheumatology and Rehabilitation volume 41, pages 92–97 (2014)Cite this article

Abstract

Aim of Work

To detect the prevalence of 25-hydroxyvitamin D3 [25(OH)D3] deficiency in rheumatoid arthritis (RA) patients and its correlation with disease activity, functional disability and bone mineral density (BMD).

Patients and Methods

Cross-sectional case control study included 104 RA patients and 60 matched controls. All patients were subjected to full history taking, clinical examination and routine laboratory investigations in addition to measurements of serum 25(OH)D3. Disease activity was assessed by 28-Disease Activity Score (DAS-28) with three variables; tender and swollen 28-joints (T-28 and S-28) and erythrocyte sedimentation rate (ESR). Functional disability was assessed by Modified Health Assessment Questionnaire (M-HAQ). BMD was measured by dual energy x-ray absorptiometry.

Results

25(OH)D3 deficiency was similar in both RA patients and controls (99.1% versus 100%). Although, the mean serum 25(OH)D3 level was less among RA patients than among controls but there was no statistical significant difference (5.98 ± 6.8 nmol/l versus 8.4 ± 9.6 nmol/l, p = 0.06). There were statistically significant correlations between 25(OH)D3 and body weight (r = –0.256, p < 0.009), T-28 (r = –0.559, p < 0.001 ), S-28 (r = –0.631, p < 0.001), DAS-28 (p < 0.001), M-HAQ (p < 0.001) scores, ESR (r = –0.39, p < 0.001) and hemoglobin (r = 0.28, p = 0.004). No significant correlation was found between 25(OH)D3 level and BMD or drug intake.

Conclusion

Although the prevalence of 25(OH)D3 deficiency is similar in both RA patients and controls but its deficiency is significantly correlated with increased disease activity and disability but not with BMD.

References

  1. McInnes I, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med 2011; 365:2205–2219.

    Article  CAS  Google Scholar 

  2. Karray EF, Ben Dhifallah I, Ben Abdelghani K, Ben Ghorbel I, Khanfir M, Houman H, et al. Associations of vitamin D receptor gene polymorphisms FokI and BsmI with susceptibility to rheumatoid arthritis and Behçet’s disease in Tunisians. Joint Bone Spine 2012; 79:144–148.

    Article  CAS  Google Scholar 

  3. Choy E. Understanding the dynamics: pathways involved in the pathogenesis of rheumatoid arthritis. Rheumatology (Oxford) 2012; 51:v3–v11.

    Article  CAS  Google Scholar 

  4. Mason R, Sequeira V, Gordon-Thomson C. Vitamin D: the light side of sunshine. Eur J Clin Nutr 2011; 65:986–993.

    Article  CAS  Google Scholar 

  5. Hewison M, Burke F, Evans KN, Lammas DA, Sansom DM, Liu P, et al. Extra-renal 25-hydroxyvitamin D3-1alpha-hydroxylase in human health and disease. J Steroid Biochem Mol Biol 2007; 103:316–321.

    Article  CAS  Google Scholar 

  6. Holick M. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011; 12:4–18.

    Article  CAS  Google Scholar 

  7. Gopinath K, Danda D. Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naive early rheumatoid arthritis: a randomised controlled trial. Endocrinol Metab Clin North Am 2010; 39:365–379.

    Article  CAS  Google Scholar 

  8. Bikle D. Vitamin D regulation of immune function. Vitam Horm 2011; 86:1–21.

    Article  CAS  Google Scholar 

  9. Merlino L, Curtis J, Mikuls T, Cerhan J, Criswell L, Saag KIowa Women’s Health Study. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004; 50:72–77.

    Article  CAS  Google Scholar 

  10. Moghimi J, Sadeghi A, Malek M, Ghorbani R. Relationship between disease activity and serum levels of vitamin D and parathyroid hormone in rheumatoid arthritis. Endocr Regul 2012; 46:61–66.

    Article  CAS  Google Scholar 

  11. Jankosky C, Deussing E, Gibson R, Haverkos H. Viruses and vitamin D in the etiology of type 1 diabetes mellitus and multiple sclerosis. Virus Res 2012; 163:424–430.

    Article  CAS  Google Scholar 

  12. Heidari B, Hajian-Tilaki K, Heidari P. The status of serum vitamin D in patients with rheumatoid arthritis and undifferentiated inflammatory arthritis compared with controls. Rheumatol Int 2011. [Epub ahead of print].

  13. Kostoglou-Athanassiou I, Athanassiou P, Lyraki A, Raftakis I, Antoniadis C. Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab 2012; 3:181–187.

    Article  CAS  Google Scholar 

  14. Song GG, Bae SC, Lee YH. Association between vitamin D intake and the risk of rheumatoid arthritis: a meta-analysis. Clin Rheumatol 2012;31:1733–1739.

    Article  Google Scholar 

  15. Aletaha D, Neogi T, Silman A, Funovits J, Felson D, Bingham C, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62:2569–2581.

    Article  Google Scholar 

  16. Prevoo MLL, van’t Hof MA, Kuper HH, van Leeuwen MA, van De Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995; 38:44–48.

    CAS  Google Scholar 

  17. Pincus T, Summey JA, Soraci SAJr, Wallston KA, Hummon NP. Assessment of patient satisfaction in activities of daily living using a modified Stanford Health Assessment Questionnaire. Arthritis Rheum 1983; 26:1346–1353.

    Article  CAS  Google Scholar 

  18. Rossini M, Maddali Bongi S, La Montagna G, Minisola G, Malavolta N, Bernini L, et al. Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease activity and disability. Arthritis Res Ther 2010; 12:R216.

    Article  CAS  Google Scholar 

  19. Haque U, Bartlett S. Relationships among vitamin D, disease activity, pain and disability in rheumatoid arthritis. Clin Exp Rheumatol 2010; 28:745–747.

    PubMed  CAS  Google Scholar 

  20. WHO. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: technical report series 843. Geneva: WHO; 1994.

    Google Scholar 

  21. Kanis JA, Glüer CCFor the Committee of Scientific Advisors, International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int 2000; 11:192–202.

    Article  CAS  Google Scholar 

  22. Braun-Moscovici Y, Toledano K, Markovits D, Rozin A, Nahir AM, Balbir-Gurman A. Vitamin D level: is it related to disease activity in inflammatory joint disease? Rheumatol Int 2011; 31:493–499.

    Article  CAS  Google Scholar 

  23. Turhanoğlu AD, Güler H, Yönden Z, Aslan F, Mansuroglu A, Ozer C. The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int 2011; 31:911–914.

    Article  CAS  Google Scholar 

  24. Zakeri Z, Sandoughi M, Mashhadi MA, Raeesi V, Shahbakhsh S. Serum vitamin D level and disease activity in patients with recent onset rheumatoid arthritis. Int J Rheum Dis 2013;18. DOI:10.1111/1756-185X.12181. [Epub ahead of print].

  25. Pakchotanon R, Chaiamnuay S, Narongroeknawin P, Asavatanabodee P. The association between serum vitamin D level and disease activity in Thai rheumatoid arthritis patients. Int J Rheum Dis 2013. DOI.10.1111/1765-185X.12222. [Epub ahead of print].

  26. Chen J, Liu W, Lin Q, Chen L, Yin J and Huang H. Vitamin D deficiency and low bone mineral density in native Chinese rheumatoid arthritis patients. Int J Rheum Dis 2014; 17:66–70.

    Article  CAS  Google Scholar 

  27. Welsh P, Peters M, McInnes I, Ems W, Lips P, McKellar G, et al. Vitamin D deficiency is common in patients with RA and linked to disease activity, but circulating levels are unaffected by TNFa blockade: results from a prospective cohort study. Ann Rheum Dis 2011; 70:1165–1167.

    Article  Google Scholar 

  28. Kerr G, Sabahi I, Richards J, Caplan L, Cannon G, Reimold A, et al. Prevalence of vitamin D insufficiency/deficiency in rheumatoid arthritis and associations with disease severity and activity. J Rheumatol 2011; 38:53–59.

    Article  Google Scholar 

  29. Quraishi MK, Badsha H. Rheumatoid arthritis disease activity and vitamin D deficiency in an Asian resident population. Int J Rheum Dis 2013. DOI: 10.1111/1756-185X.12209. [Epub ahead of print].

  30. Craig S, Yu F, Curtis J, Alarcón G, Conn D, Jonas B, et al. Vitamin D status and its associations with disease activity and severity in African Americans with recent-onset rheumatoid arthritis. J Rheumatol 2010; 37:275–281.

    Article  CAS  Google Scholar 

  31. Baker J, Baker D, Toedter G, Shults J, Von Feldt J, Leonard M. Associations between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:658–664.

    PubMed  Google Scholar 

  32. Weiss S. Bacterial components plus vitamin D: the ultimate solution to the asthma (autoimmune disease) epidemic? J Allergy Clin Immunol 2011; 127:1128–1130.

    Article  Google Scholar 

  33. Vanlint S. Vitamin D and obesity. Nutrients 2013; 5:949–956.

    Article  CAS  Google Scholar 

  34. Parikh SJ, Edelman M, Uwaifo GI, Freedman RJ, Semega-Janneh M, Reynolds J, et al. The relationship between obesity and serum 1,25-dihydroxy vitamin D concentrations in healthy adults. J Clin Endocrinol Metab 2004; 89:1196–1199.

    Article  CAS  Google Scholar 

  35. Lagunova Z, Porojnicu A, Lindberg F, Hexeberg S, Moan J. The dependency of vitamin D status on body mass index, gender, age and season. Anticancer Res 2009; 29:3713–3720.

    PubMed  CAS  Google Scholar 

  36. Hagaman J, Panos R, McCormack F, Thakar C, Wikenheiser-Brokamp K, Shipley R, et al. Vitamin D deficiency and reduced lung function in connective tissue-associated interstitial lung diseases. Chest 2011; 139:353–360.

    Article  CAS  Google Scholar 

  37. Baker JF, Baker DG, Toedter G, Shults J, Von Feldt JM, Leonard MB. Association between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:658–664.

    PubMed  Google Scholar 

  38. Hewison M. Vitamin D and immune function: autocrine, paracrine or endocrine? Scand J Clin Lab Invest Suppl 2012; 243:92–102.

    PubMed  Google Scholar 

  39. Mora JR, Iwata M, von Andrian UH. Vitamin effects on the immune system: vitamins A and D take centre stage. Nat Rev Immunol 2008; 8:685–698.

    Article  CAS  Google Scholar 

  40. Bartels L, Hvas C, Agnholt J, Dahlerup J, Agger R. Human dendritic cell antigen presentation and chemotaxis are inhibited by intrinsic 25-hydroxy vitamin D activation. Int Immunopharmacol 2010; 10:922–928.

    Article  CAS  Google Scholar 

  41. Jirapongsananuruk O, Melamed I, Leung D. Additive immunosuppressive effects of 1,25-dihydroxyvitamin D3 and corticosteroids on TH1, but not TH2, responses. J Allergy Clin Immunol 2000; 106:981–985.

    Article  CAS  Google Scholar 

  42. Merlino LA, Curtis J, Mikuls TR, Cerhan JR, Criswell LA, Saag KGIowa Women’s Health Study. Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study. Arthritis Rheum 2004; 50:72–77.

    Article  CAS  Google Scholar 

  43. Chen S, Sims G, Chen X, Gu Y, Chen S, Lipsky P. Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol 2007; 179:1634–1647.

    Article  CAS  Google Scholar 

  44. Varenna M, Manara M, Cantatore F, Del Puente A, Di Munno O, Malavolta N, et al. Determinants and effects of vitamin D supplementation on serum 25-hydroxy-vitamin D levels in patients with rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:714–719.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Al-Saraya Street, Cairo, 11451, Egypt

    Nashwa T. Allam, Mohamed M. El-Wakd MD & Dalia A. Dorgham

  2. Clinical and Chemical Pathology Department, Faculty of Medicine, Cairo University, Cairo, Egypt

    Dina M. El-Abd

Authors
  1. Nashwa T. Allam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mohamed M. El-Wakd MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Dina M. El-Abd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dalia A. Dorgham
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mohamed M. El-Wakd MD.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Allam, N.T., El-Wakd, M.M., El-Abd, D.M. et al. Prevalence of vitamin D deficiency in Egyptian rheumatoid arthritis patients: correlation with disease activity, functional disability, and bone mineral density. Egypt Rheumatol Rehabil 41, 92–97 (2014). https://doi.org/10.4103/1110-161X.140521

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/1110-161X.140521

Keywords