AB0287 High Levels of 25(OH)D Are Associated with Lower Disease Activity in Patients with Newly Diagnosed Rheumatoid Arthritis

• Published in: Annals of the rheumatic diseases Vol. 74; no. Suppl 2; p. 989
• Main Authors: Rasch, L.A., Konijn, N.P.C., Krul-Poel, Y.H.M., van Tuyl, L.H.D., Raterman, H.G., Ter Wee, M.M., den Uyl, D., Simsek, S., Nurmohamed, M., Lems, W.F.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2015
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2015-eular.3746

BackgroundVitamin D deficiency is highly common in patients with rheumatoid arthritis (RA) (1). In vitro, vitamin D has anti-inflammatory effects and vitamin D has been linked to disease activity in RA due to its immuno-modulatory properties (1,2).ObjectivesTo investigate the association between vitamin D status and disease activity in newly diagnosed RA patients before start of therapy.MethodsConsecutive patients with active, newly diagnosed RA (symptom duration <2 years), were randomized for treatment with COBRA or COBRA-light therapy (3). Before start of therapy, baseline values were determined, including Disease Activity Score (44 joint; DAS) and serum 25-hydroxy vitamin D (25(OH)D) levels. Based on the widely used cut-off values, patients were stratified into three groups based on baseline serum 25(OH)D levels: <50 nmol/l, 50-74 nmol/l, and ≥75 nmol/l.ResultsBaseline serum 25(OH)D levels were determined in 147 of 164 included RA patients in the COBRA-light trial (90% of trial population). Serum 25(OH)D levels of the different groups are presented in Table 1. Patients with a baseline serum 25(OH)D level ≥75 nmol/l had a significant lower mean DAS compared to patients with a baseline serum 25(OH)D <75 nmol/l (p=0.001). Vitamin D deficient patients (<50 nmol/l) had a significant shorter symptom duration (p=0.003), and were more often rheumatoid factor positive (p=0.015) compared to patients with sufficient serum 25(OH)D levels.Table 1.Vitamin D status and disease related factors of patients with newly diagnosed rheumatoid arthritis before start of therapySerum 25(OH)DSerum 25(OH)DSerum 25(OH)D<50 nmol/l50–74 nmol/l≥75 nmol/l(n=62; 42%)(n=50; 34%)(n=35; 24%)Disease Activity Score (DAS, 44 joints)4.2 (0.7)4.0 (0.9)3.6 (0.7)*Symptom duration (weeks)12 [8,21]*18 [8,49]25 [13,36]Health Assessment Questionnaire score (HAQ, 0 to 3)1.5 (0.8)1.3 (0.6)1.2 (0.6)Serum 25(OH)D (nmol/l)36 [25,46]61 [54,67]87 [81,100]Rheumatoid factor positive (n (%))44 (72)†22 (45)20 (57)aCCP positive (n (%))44 (71)26 (53)25 (71)Values are reported as mean (SD) or median [IQR], unless otherwise specified. *Differs significantly from both other groups (p-value<0.05); †Differs significantly from serum 50-74 nmol/l (p-value<0.05). 25(OH)D: 25-hydroxy vitamin D; aCCP: antibodies against cyclic citrullinated peptides.ConclusionsNewly diagnosed RA patients with serum 25(OH)D levels ≥75 nmol/l demonstrate a significant lower disease activity than patients with a serum 25(OH)D level <75 nmol/l before start of therapy. This study cannot distinguish whether a lower DAS at baseline is caused by immuno-modulatory properties due to higher serum 25(OH)D levels, or that higher serum 25(OH)D levels are caused by more frequent outdoor activities related to a lower DAS. Since 75% of the newly diagnosed RA patients have insufficient serum 25(OH)D levels (<75 nmol/l), vitamin D supplementation should be considered in every newly diagnosed RA patient.ReferencesGrazio S, et al. Am J Med Sci 2014.Baker JF, et al. Clin Exp Rheumatol 2012.Den Uyl D, et al. Ann Rheum Dis 2013.Disclosure of InterestL. Rasch: None declared, N. Konijn: None declared, Y. Krul-Poel: None declared, L. van Tuyl: None declared, H. Raterman: None declared, M. ter Wee: None declared, D. den Uyl: None declared, S. Simsek: None declared, M. Nurmohamed: None declared, W. Lems Grant/research support from: This research was performed within the framework of project T1-106 of the Dutch Top Institute Pharma, and was additionally funded by an unrestricted grant from Pfizer.