Determinants and effects of vitamin D supplementation on serum 25-Hydroxy-vitamin D levels in patients with rheumatoid arthritis.
Clin Exp Rheumatol. 2012 Jul 4.
Varenna M, Manara M, Cantatore FP, Del Puente A, Di Munno O, Malavolta N, Minisola G, Adami S, Sinigaglia L, Rossini M.
Rheumatology Unit, Istituto Ortopedico Gaetano Pini, Milano, Italy. varenna at gpini.it.
Osteoporosis (OP) and increased risk of fracture are relevant features in patients with rheumatoid arthritis (RA).
Low levels of serum vitamin D are frequently reported and correlate with a higher RA activity.
This study evaluated factors related with the prescription of vitamin D supplements in RA patients and variables influencing the achievement of adequate vitamin D levels.
Study population was made up by 1168 consecutive RA patients from 22 Italian rheumatology centers.
Demographic and clinical variables data were collected and 25OH serum vitamin D was measured in all patients.
Insufficient serum 25OH vitamin D levels were defined as values lower than 20 ng/mL.
The majority of patients (56.0%) was not taking vitamin D supplements. Among the 514 supplemented patients, 196 (38.1%) were taking insufficient dosages (?440 IU/day). Variables related with the prescription of supplements were older age, female sex, previous bone density assessment and OP diagnosis. Among the 318 patients using daily supplements ?800 IU, 88 patients (27.7%) did not reach adequate levels of vitamin D. In these patients a higher HAQ score (OR for 1 point=1.62, 95% CI: 1.06-2.49; p=0.03) and poor sun exposure (OR=2.38, 95% CI: 1.05-5.55; p=0.04) were predictors of vitamin D insufficiency.
Vitamin D deficiency is common in patients with RA, even in patients who are regularly using supplements.
Vitamin D supplementation is often ineffective even at the recommended dose of 800 IU/day in more disabled patients.
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