Rheumatic Diseases often treated by Vitamin D, may need 40-60 ng – Oct 2021

Vitamin D and Rheumatic Diseases: A Review of Clinical Evidence

Int. J. Mol. Sci. 2021, 22, 10659. https://doi.org/10.3390/ijms221910659
Nipith Charoenngam 1,2,3

1. Dept of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA 02138, USA;
    ~  nipith.charoenngam at gmail.com   or perhaps ncharoen at bu.edu
2. Section Endocrinology, Diabetes, Nutrition and Weight Management, Dept of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
3. Department of Medicine, Faculty of Medicine SirirajHospital, Mahidol University, Bangkok 10700, Thailand

Vitamin D plays an important role in maintaining a healthy mineralized skeleton. It is also considered an immunomodulatory agent that regulates innate and adaptive immune systems. The aim of this narrative review is to provide general concepts of vitamin D for the skeletal and immune health, and to summarize the mechanistic, epidemiological, and clinical evidence on the relationship between vitamin D and rheumatic diseases.

Multiple observational studies have demonstrated the association between a low level of serum 25-hydroxyvitamin D [25(OH)D] and the presence and severity of several rheumatic diseases, such as

• rheumatoid arthritis (RA),
• systemic lupus erythematosus (SLE),
• spondyloarthropathies, and
• osteoarthritis (OA).

Nevertheless, the specific benefits of vitamin D supplements for the treatment and prevention of rheumatic diseases are less accepted as the results from randomized clinical trials are inconsistent, although some conceivable benefits of vitamin D for the improvement of disease activity of RA, SLE, and OA have been demonstrated in meta-analyses. It is also possible that some individuals might benefit from vitamin D differently than others, as inter-individual difference in responsiveness to vitamin D supplementation has been observed in genomic studies. Although the optimal level of serum 25(OH)D is still debatable, it is advisable it is advisable that patients with rheumatic diseases should maintain a serum 25(OH)D level of at least 30 ng/mL (75 nmol/L) to prevent osteomalacia, secondary osteoporosis, and fracture, and possibly 40-60 ng/mL (100-150 nmol/L) to achieve maximal benefit from vitamin D for immune health and overall health.

Conclusions

Vitamin D plays an essential role in not only maintaining healthy mineralized skeleton, but also modulating the innate and adaptive immune systems in a way that is thought to benefit as an adjunctive treatment for many immune-mediated diseases. A low level of 25(OH)D is associated with the presence and severity of most, if not all, rheumatic diseases, such as RA, SLE, SpA, and OA. However, the benefits of vitamin D supplement for the treatment and prevention of these diseases are relatively unclarified, as the results from existing clinical trials are markedly inconsistent. Many of them are small in sample size and likely underpowered; however, when those results were pooled in meta-analyses, there were conceivable signals of the benefits of vitamin D for the improvement of disease activity, particularly for RA and SLE. It is also worth noting that, based on recent genomic studies on vitamin D, there might be inter-individual difference in responsiveness to vitamin D supplementation that need further investigations, suggesting that some individuals might be able to benefit from vitamin D more or less than others. Regardless of the evidence on the disease-specific benefits of vitamin D, it is advisable that patients with rheumatic disease with or without corticosteroid therapy should have sensible sunlight exposure and adequate vitamin D intake to maintain serum 25(OH)D level at least 30 ng/mL (75 nmol/L) in order to prevent osteomalacia, secondary osteoporosis, and fracture, and possibly 40-60 ng/mL (100-150 nmol/L) to achieve the maximal benefit from vitamin D for immune health and overall health.
 Download the PDF from VitaminDWiki

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VitaminDWiki

Rheumatoid Arthritis category starts with

118 RA items     See also Overview Rheumatoid Arthritis   Autoimmune  Inflammation   Pain - Chronic

    Highlights of RA studies in VitaminDWiki
RA worse if low Vitamin D

• Rheumatoid Arthritis score extrapolates to zero at 51 ng of Vitamin D (India) – June 2024
• Rheumatoid Arthritis is more severe if low vitamin D – July 2023
• Rheumatoid arthritis pain was 5.8 X more likely if low vitamin D – Aug 2017
• Adaptive and innate immune system, vitamin D genes, and Rheumatoid Arthritis – June 2019
• Rheumatoid Arthritis strongly associated with low vitamin D – meta-analysis April 2016
• Rheumatoid Arthritis associated with lower vitamin D and higher latitude – meta-analysis Jan 2016

10 RA and Vitamin D Receptor (auto-updated)

RA Treated by Vitamin D

• Several rheumatic diseases treated by high-dose vitamin D, but made worse if Calcium was added – April 2022
• Rheumatic Diseases often treated by Vitamin D, may need 40-60 ng – Oct 2021
• Rheumatoid Arthritis pain reduced by monthly 100,000 IU of Vitamin D – Oct 2018
• Rheumatoid arthritis reduced by 440,000 IU of Vitamin D over 4 months – Oct 2015
• Connective tissue disorders (Lupus, RA, etc) treated by vitamin D – May 2016
• 43 percent of Rheumatoid Arthritis patients have Vitamin D prescriptions (15 countries) – June 2017
• Big increase in vitamin D supplementation in just 2 years after Swiss rheumatology report – Dec 2013
• High dose vitamin reduced pain of fibromyalgia, osteoarthritis, and rheumatoid arthritis - July 2015
  • Note: Vitamin D receptor problems (such as RA) are best treated by infrequent large doses of Vitamin D

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Osteoarthritis category includes the following

61 items total - see also Overview Osteoporosis and vitamin D

Overview Osteoarthritis and Vitamin D
Knee Osteoarthritis treated by Vitamin D - meta-analysis Aug 2023
See also Ankylosing spondylitis
Rheumatic Diseases often treated by Vitamin D, may need 40-60 ng – Oct 2021
Knee osteoarthritis: Vitamin D is the 4th best treatment – meta-analysis Oct 2020

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Lupus contains the following summary

78 items in LUPUS category

Some of the studies in VitaminDWiki

• Every aspect of Lupus is associated with low viramin D – Oct 2021
• It is time to routinely give vitamin D to Lupus patients – Dec 2016
• 93 pcnt of these Lupus patients supplemented with Vitamin D - Nov 2020
• Lupus patients are 5 X more likely to have low vitamin D – many meta-analyses
• Lupus fought by Vitamin D in all trials longer than 12 weeks - review Sept 2017

See also Autoimmune: 204 items    Rheumatoid Arthritis: 118 items

Autoimmune disease, mainly in 50 per 100,000 women, no cure, many parts of body Wikipedia

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Overview Fibromyalgia or Chronic Fatigue and vitamin D
similar symptoms to Long-Haul COVID-19