Vitamin D Status and Response to Supplementation as Predictive Factors for Early Remission in Polymyalgia Rheumatica: A Retrospective Longitudinal Investigation
Nutrients Volume 17 Issue 17 10.3390/nu17172839
by Elvis Hysa 1,2,†ORCID,Serena Balito 1,3,†,Giulia Davoli 1,3,Elisa Caratto 1,3,Giulia Bernardi 1,3,Emanuele Gotelli 1,3,Rosanna Campitiello 1,2,Carmen Pizzorni 1,3,Sabrina Paolino 1,3,Alberto Sulli 1,3ORCID,Vanessa Smith 4,5,6 andMaurizio Cutolo 1,3,*ORCID
Background/Objectives: Polymyalgia rheumatica (PMR) is a relatively common inflammatory rheumatic disease of the elderly. The role of vitamin D remains unclear in this condition. The endpoints of this study were to assess 25-hydroxyvitamin D [25(OH)D] serum concentrations in PMR patients with active disease compared to elderly controls and to determine if baseline levels or changes following supplementation [delta 25-hydroxyvitamin D, Δ25(OH)D] were associated with improved clinical outcomes.
Methods: In this retrospective, case–control study, 29 PMR patients (55% males, 75.24 ± 9.6 years old, disease duration of 3.8 ± 3 months) were included, meeting the 2012 EULAR/ACR classification criteria, with 29 age- and sex-matched controls without systemic inflammatory rheumatic diseases. We assessed demographic, clinical and laboratory features for PMR patients, including baseline 25(OH)D serum concentrations, disease activity (polymyalgia rheumatica activity score), and serum inflammatory biomarkers. A subgroup of them (n = 25) was followed longitudinally, for an average period of 21.1 ± 17.7 months, to evaluate the association between Δ25(OH)D and clinical outcomes at follow-up using multivariate logistic regression.
Results: Although lower than the normal reference values, baseline 25(OH)D concentrations did not differ significantly between PMR patients and controls (21.6 ± 9.2 vs. 22.7 ± 11.3 ng/mL, p = 0.66) and did not predict long-term clinical outcomes. However, after only 3 months of supplementation, the increase in 25(OH)D concentrations was significantly associated with a remission status, and patients in remission showed a significant increase in 25(OH)D compared to those with persistent disease activity (+22.02 vs. +1.33 ng/mL, respectively; p = 0.044). Notably, in the multivariate model, this Δ25(OH)D was the strongest independent predictor of remission (OR = 2.89; 95% CI [1.60–4.11]), an effect independent of prednisone dosage prescribed at first visit (p = 0.32) and glucocorticoid exposure at third month (p = 0.12).
Conclusions: Individual’s response of PMR patients to supplementation of vitamin D seems to be a robust independent predictor of early clinical remission achievement. Interestingly, optimizing vitamin D supplementation based on individual responsiveness may represent a valuable adjunctive strategy in PMR management.
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Vitamin D supplementation was prescribed at the first visit (V0) to all patients. The majority received cholecalciferol (n = 22,88%), with mean daily dosages of 2104.5 ± 743.7 international units (IU). Cholecalciferol was administered using different schemes:
- a monthly dosage of 25.000 IU (n = 12), weekly
- or every other week doses (n = 6),
- or a daily regimen (n = 4).
Calcidiol was prescribed to three patients (12%) with a mean daily dosage of 1733.3 ± 230.9 IU and as daily drops.
This initial supplementation protocol was then adjusted during subsequent follow-ups based on the observed changes in serum 25(OH)D levels, with the clinical goal of reaching and maintaining minimal sufficient concentrations (>40 ng/mL). Over the 24-month observation period, this tailored approach led to a statistically significant increase in serum vitamin D concentrations from baseline, which occurred concurrently with a significant and sustained reduction in inflammatory biomarkers, including both ESR and CRP (Figure 1).
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