Written by Greg Arnold, DC, CSCS. In a study of 300 adults with rheumatoid arthritis, those in the severly deficient vitamin D group were positive for rheumatoid factor compared to 77.5% of all others.
Rheumatoid arthritis affects 1.3 million Americans (1) and is characterized by joint pain, stiffness, morning stiffness that may last hours, red and puffy hands, fatigue, and weight loss (2). Rheumatoid arthritis by itself costs our healthcare system $11,404 per patient per year, but as it is also a risk factor for cardiovascular disease and depression, total costs can increase to $14,145 and $12,225 per patient, respectively (3).
Now a new study (4) suggests that vitamin D deficiency may increase the risk for rheumatoid arthritis. The study involved 300 patients in Denmark over the age of 18 and diagnosed with rheumatoid arthritis (5). They had their blood levels drawn to measure the severity of their rheumatoid arthritis with a test called the DAS28-3w. They also completed a visual analog pain scale that ranged from 0 (no pain) to 100 (worst possible pain). Finally, the researchers defined vitamin D deficiency as having blood levels below 50 nanomoles per liter, as agreed upon in previous research (6).
The researchers found that 33.4% of the patients (101/300) were vitamin D deficient. While there was no significant differences in DAS28-3w and visual analog scores between the deficient patients and the rest of the group, there were significant differences for the 15 patients who were “severely deficient”, having vitamin D levels less than 15 nmol/L, and the rest of the group. Specifically:
– All 15 severely deficient patients were positive for rheumatoid factor compared to 77.5% of the rest of the group (p = 0.05)
– The 15 severely deficient patients had 94% higher levels of an inflammatory protein called C-reactive protein (28.7 vs. 14.8 milligrams per Liter, p = 0.001)
– 40% of the severely deficient patients were taking at least 3 disease-modifying anti-rheumatic drugs (DMARDs) compared to only 14.5% of the rest of the group (p=0.02)
– 20% of the severely deficient patients had a DAS28-3w score greater than 5.1 compared to 4.5% of the rest of the group p=0.01)
While the researchers admit that vitamin D supplementation has been shown to help with pain relief in rheumatoid patients (7), there is no research on whether vitamin D supplementation may influence the progression of rheumatoid arthritis. Nevertheless, they agree with previous research (8) that due to “the increasing adverse health outcomes associated with hypovitaminosis D, screening and supplementation should be performed routinely in the rheumatoid arthritis patient population.”
Source: Haga, Hans-Jacob, Anne Schmedes, Yusuf Naderi, Alicia Martin Moreno, and Elisabeth Peen. “Severe deficiency of 25-hydroxyvitamin D3 (25-OH-D3) is associated with high disease activity of rheumatoid arthritis.” Clinical rheumatology 32, no. 5 (2013): 629-633.
© Clinical Rheumatology 2013
Posted October 31, 2013.
Greg Arnold is a Chiropractic Physician practicing in Hauppauge, NY. You can contact Dr. Arnold directly by emailing him at PitchingDoc@msn.com or visiting his web site at www.PitchingDoc.com
References:
- “Arthritis Related Statistics” posted on the CDC website.
- “Rheumatoid Arthritis” posted on the Mayo Clinic website.
- Joyce AT. Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disease and depression among patients with RA. J Rheumatol 2009 Apr;36(4):743-52. Epub 2009 Feb 17.
- Haga HJ. Severe deficiency of 25-hydroxyvitamin D(3) (25-OH-D (3)) is associated with high disease activity of rheumatoid arthritis. Clin Rheumatol 2013 Jan 15. [Epub ahead of print]
- Arnett FC. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31:315– 324.
- Van Gestel AM. Evaluation of established rheumatoid arthritis. Baillieres Clin Rheumatol 1999;13:629–644.
- Mosekilde L. Vitamin D-mangel: definition og prævalens i Danmark. Dan Med Bull 2005; 167(1):29–33.
- Gopinath K. Supplementation of 1,25 dihydroxy vitamin D3 in patients with treatment naïve early rheumatoid arthritis: a randomized controlled trial. Rheum Dis 2011; 14:332–339.
