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Rheumatoid arthritis associated with low vitamin D – Fibromyalgia makes it even lower – Oct 2014

Vitamin D status in rheumatoid arthritis patients: relation to clinical manifestations, disease activity, quality of life and fibromyalgia syndrome

International Journal of Rheumatic Diseases, DOI: 10.1111/1756-185X.12426
Tamer A. Gheita1,*, Safaa Sayed1, Heba A. Gheita2 andSanaa A. Kenawy3
1Department of Rheumatology, Faculty of Medicine, Cairo University, Cairo, Egypt
2Department of Pharmacology, Atomic Energy Authorization, Cairo, Egypt
3Department of Pharmacology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
* Correspondence: Tamer A. Gheita, MD, Rheumatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt. Email: gheitamer at hotmail.com

VitaminDWiki Summary

Average age 42 (total of 125 patients)
33 ng: No RA or FMS = Controls
27 ng: RA without FMS
19 ng: RA with FMS
No indication of levels if FMS without RA


Aim
To assess vitamin D levels in rheumatoid arthritis (RA) patients and to find their relation to clinical parameters, fibromyalgia syndrome (FMS), quality of life (QoL) and disease activity.

Methods
The study included 63 RA patients and 62 controls. Clinical examination and laboratory investigations were performed. For patients, the Disease Activity Score (DAS-28), QoL index, Health Assessment Questionnaire II (HAQ II) and Modified Larsen score were calculated. 25-OH-vitamin D was measured in patients and controls.

Results
The patients’ mean age was 41.59 ± 9.69 years and disease duration 5.89 ± 3.67 years. The level of vitamin D in RA patients was significantly lower (23.11 ± 12.71 ng/mL) than that in the controls (32.59 ± 13.06 ng/mL) (P = 0.005) being deficient in 50.8%, insufficient in 23.8% and normal in 25.4%. The RA patients with FMS (n = 33) had significantly lower levels of vitamin D (19.08 ± 10.59 ng/mL) than those without (27.55 ± 13.51 ng/mL) (P = 0.008). The difference was significant on comparing those receiving hydroxychloroquine (17.39 ± 7.84 ng/mL) to those not (31.85 ± 13.85 ng/mL) (P < 0.001). Vitamin D significantly correlated with QoL index (r = 0.58, P < 0.001) and negatively with HAQ II (r = −0.36, P = 0.004) and BMI (r = −0.39, P = 0.001).

Conclusion
Special attention is required regarding vitamin D levels in RA patients with FMS and decreased QoL. Vitamin D should be corrected and supplementation considered among the RA management armamentarium.

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