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Patients with RA, low vitamin D levels responded poorly to treatment
Patients with early rheumatoid arthritis and low levels of vitamin D did not respond as well to treatment as patients with normal levels of vitamin D, according to researchers at Sapienza University of Rome.
The longitudinal, observational, retrospective study included 37 patients (31 women) diagnosed with rheumatoid arthritis (RA) in 24 weeks or less who had not yet begun treatment. Patients were enrolled between 2010 and 2012 and had a mean age was 47 years.
In addition to serum vitamin D concentrations, baseline clinical data, medical history and laboratory values of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor and anti-citrullinated protein antibodies (ACPAs) were collected.
Examination and assessment of disease activity was made using the number of tender and swollen joints on the basis of a 28-joint count and 44-joint count, the Ritchie index, a VAS for pain and disease activity, the examiner's global disease activity assessment, patient global health assessment and the 28-joint Disease Activity Score (DAS28). Diagnosis was based on the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria. Ultrasound was performed at baseline and at 12-month follow-up.
After 12 months, patients were reevaluated and ACR/EULAR response was calculated based on DAS28. Patients were considered good responders in the presence of an improvement of at least 1.2 units and have an overall score of less than 3.2. Patients were considered non-responders if they had a final DAS28 score of greater than 5.1 and an improvement of less than 0.6 or more than 0.6 but less than or equal to 1.2. Patients were classified as moderate responders when scores were in between the two parameters.
At baseline, serum vitamin D levels were not associated with DAS28, and no significant clinical or laboratory differences were seen between patients with low or normal vitamin D levels, according to the researchers.
After 12 months of follow-up, disease activity was significantly reduced after treatment with corticosteroids and methotrexate, and a good or moderate response was shown in 91.7% of patients. Remission was achieved by 48% of patients, but among patients with low vitamin D, the response was lower overall. Of patients with normal levels of vitamin D, 75% were good responders and 75% showed a moderate response, but among patients with low vitamin D levels at baseline, only 4% showed good response and 96% had a moderate response.
Bivariate correlation analyses showed that remission after treatment was associated with baseline vitamin D levels, but levels did not correlate with BMI, CRP, DAS28, ACPA or certain other clinical characteristics. - by Shirley Pulawski
Disclosure: The researchers report no relative financial disclosures.