Findings from a recent longitudinal study published in the journal BMC Musculoskeletal Disorders revealed treatment with vitamin D reduces disease activity in patients with early Rheumatoid Arthritis and basal hypovitaminosis D. The findings strongly support the role of the immunomodulatory action of vitamin D in RA and also indicate a role of basal vitamin D status in the prediction of disease evolution.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that is characterized by joint involvement and systemic features that gradually leads to disability and early death. Estimates show that the condition affects about 1% of the population, with higher prevalence in women.
It has been demonstrated that the active form of vitamin D, aside from its role in calcium and bone homeostasis, also displays an anti-inflammatory role acting on Th17 cells, contributing to the maintenance of the immunological homeostasis. Studies in RA murine models have shown that vitamin D was able to prevent the onset and progression of arthritis, and results from epidemiological studies showed a higher prevalence of vitamin D deficiency among patients affected by RA. There is a lack of longitudinal studies investigating the role of vitamin D levels at RA diagnosis on the prediction of disease’s activity, remission and response to treatment are missing.
To address this unmet need, in the study titled “Hypovitaminosis D in recent onset rheumatoid arthritis is predictive of reduced response to treatment and increased disease activity: a 12 month follow-up study,” Manuela Di Franco from the Rheumatology Unit-Department of Internal Medicine and Medical Specialties, Sapienza University of Rome in Italy and colleagues examined the association between serum 25(OH) vitamin D levels at the diagnosis of RA and: 1- the disease’s activity evaluated by clinimetric, laboratory and ultrasound (US) parameters, 2- the prevalence of remission and response to treatment in a population of patients affected by early RA naïve for DMARDs treatment, after 12 months of follow-up.
In a total of 37 patients with early RA, results showed that the baseline mean of 25(OH) vitamin D levels were 24.4 ± 11.9 ng/ml. A total of 35% of RA patients had hypovitaminosis D and this feature was associated with higher RA activity and lower prevalence of remission and response to treatment. The percentage of patients not presenting a reduction of the US synovitis score after 12 months from diagnosis was higher those RA patients with hypovitaminosis D compared to those patients with baseline normal serum 25(OH) vitamin D levels.
Based on these results, the researchers suggest that Vitamin D assessment and supplementation should be considered an additional treatment option for the management of patients with early RA.