Vitamin D deficiency Associates with Disease Severity in Rheumatoid Arthritis Patients
Keywords:RA, vitamin D, anti-CCP, anti-dsDNA
Vitamin D considered as a key player in various autoimmune disorders, such as rheumatoid arthritis, due to its immunological modulatory effect. Together with Anti-double stranded DNA (Anti-dsDNA), Anti-cyclic citrullinated peptide (Anti-CCP) is considered among the indicators of the disease severity in rheumatoid arthritis. The present study aimed to measure the level of vitamin D in RA patients besides measuring anti-dsDNA, anti-CCP, RF, complete blood count (CBC) and Erythrocyte Sedimentation Rate (ESR) for comparing it with its corresponding level in healthy control group. This study was a descriptive cross-sectional study involving sequential RA patients who visited the Rheumatology clinic for outpatients during three-months period starting from July 2018, at the Baghdad Teaching Hospital. Sixty individuals (30 RA patients and 30 age and gender matched healthy control) were enrolled in this study. Blood samples were collected and serum levels of anti-dsDNA, 25-hydroxy vitamin D (25[OH]), anti-CCP and RF besides C3, C4, CBC and ESR were measured. A highly significant decrease was displayed in the mean level of vitamin D in RA patients (18.67±17.70 ng/mL) when compared to its level in the control group (35.07 ±3.71 ng/mL), (normal value: 20 and 40 ng/mL), whereas, anti-dsDNA level normal value: (<30.0 IU/mL) was significantly increased in RA patients (122.27±65.89 IU/ml) as compared to its mean level in the control group (17.77±3.56 IU/ml) with an inverse relationship between anti-dsDNA levels vitamin D levels in RA patients. No statistical difference noted in C3 and C4 levels between patients and control groups. Rheumatoid arthritis patients with positive RF had statistically higher anti-CCP (normal value: less than 20 U/ml) than those with negative RF (39.83±11.449 vs 21.67±4.658 u/ml). As expected, a highly significant increase was observed in ESR of patients when compared to that of the control. In addition, an alteration was noted in some circulating blood cells count.
L. L. W Ishikawa, P. M. Colavite, T. F de Campos Fraga-Silva, L. A. N Mimura, T. G. D França, S. F. G. Zorzella-Pezavento, F. Chiuso-Minicucci, L. D. Marcolino, M. Penitenti, M. R. V. Ikoma. Vitamin D deficiency and rheumatoid arthritis. Clinical reviews in allergy & immunology. 2017;52(3):PP373-88.
A. Silman, L. Klareskog, F. Breedveld,B. Bresnihan,R. Maini, P. Van Riel,D. Symmons. Proposal to establish a register for the long term surveillance of adverse events in patients with rheumatic diseases exposed to biological agents: the EULAR Surveillance Register for Biological Compounds. Annals of the rheumatic diseases. 2000;59(6):PP419-20.
J.Sokolove. Rheumatoid Arthritis Pathogenesis and Pathophysiology. Lung Disease in Rheumatoid Arthritis: Springer; 2018. PP. 19-30.
G. Steiner, J. Smolen Autoantibodies in rheumatoid arthritis and their clinical significance. Arthritis research & therapy. 2002;4(2):PP1-5.
N. Charoenngam, M. F. Holick. Immunologic effects of vitamin D on human health and disease. Nutrients. 2020;12(7):PP 2097.
Y. H. Lee, S. C. Bae. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: a meta-analysis. Clinical and experimental rheumatology. 2016;34(5):PP 827-33.
M. M Aslam, P. John, A. Bhatti, S. Jahangir, M. I. Kamboh. Vitamin D as a Principal Factor in Mediating Rheumatoid Arthritis-Derived Immune Response. BioMed research international. 2019;2019:PP 3494937. 10.1155/2019/3494937
U. Singh, A. Vishwanath, P. K. Verma, N. K. Singh, R. C. Shukla, S. Singh, S. Singh, G. K. Sonkar. Is rheumatoid factor still a superior test for the diagnosis of rheumatoid arthritis? Rheumatology international. 2010;30(8):PP1115-9.
V. Malmström, A.I.Catrina, L. Klareskog L. The immunopathogenesis of seropositive rheumatoid arthritis: from triggering to targeting. Nature Reviews Immunology. 2017;17(1):PP60.
R. H. Hussein, I. A. MezherAl-Rayahi, K.Taha. Rheumatoid factor isotypes in a sample of Iraqi rheumatoid arthritis patients. Journal of Global Pharma Technology. 2018;10(8):PP141-5.
D. Sieghart, A. Platzer ,P. Studenic F. Alasti, M. Grundhuber, S. Swiniarski, T.Horn, H. Haslacher,S. Blüml,J. Smolen. Determination of autoantibody isotypes increases the sensitivity of serodiagnostics in rheumatoid arthritis. Frontiers in immunology. 2018;PP 9:876.
T. G. Nguyen, K. J. McKelvey, L. M. March, D. J. Hunter, M. Xue, C. J. Jackson, J. M. Morris. Aberrant levels of natural IgM antibodies in osteoarthritis and rheumatoid arthritis patients in comparison to healthy controls. Immunology letters. 2016;170:PP27-36.
M. F. Holick. Vitamin D status: measurement, interpretation, and clinical application. Annals of epidemiology. 2009;19(2):PP73-8.
B. A. Hamad. Relationship between vitamin D3 level and rheumatoid arthritis patients attending Rizgary Teaching Hospital in Erbil city. Zanco Journal of Medical Sciences (Zanco J Med Sci). 2017;21(2):PP1736-42.
S. T. Weiss. Bacterial components plus vitamin D: the ultimate solution to the asthma (autoimmune disease) epidemic? Journal of Allergy and Clinical Immunology. 2011;127(5):PP1128-30.
L. E. Bartels, C. L. Hvas, J. Agnholt, J.F. Dahlerup,R. Agger. Human dendritic cell antigen presentation and chemotaxis are inhibited by intrinsic 25-hydroxy vitamin D activation. International immunopharmacology. 2010;10(8):PP 922-8.
A.M.Al-Gebori,M.H.M Alosami., N.H. Al-Hashimi. Prevalence Of 25-Hydroxy Vitamin D Deficiency And Some Biochemical Parameters In Iraqi Patients With Rheumatoid Arthritis And Their Associations With Disease Activity. Prevalence. 2020;13(4).
D. M. Ahmed, D. F. Salloom. The Association between Toll-like Receptor 7 and Hepatitis C Virus in a Sample of Iraqi Rheumatoid Arthritis Patients. Journal of Global Pharma Technology. 2018;1:PP1-8.
S. F. Nielsen, S. E. Bojesen, P. Schnohr., B. G. Nordestgaard. Elevated rheumatoid factor and long term risk of rheumatoid arthritis: a prospective cohort study. BMJ. 2012;PP345.
E. T. Molenaar, A. E. Voskuyl,A. Familian., G.J.van Mierlo,B.A. Dijkmans,C.E. Hack. Complement activation in patients with rheumatoid arthritis mediated in part by C‐reactive protein. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2001;44(5):PP997-1002.
E. T. Ali, A. S. Jabbar, A. N. Mohammed. A comparative study of interleukin 6, inflammatory markers, ferritin, and hematological profile in rheumatoid arthritis patients with anemia of chronic disease and iron deficiency anemia. Anemia. 2019.
T. Sokka, T. Pincus. Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%-45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States. The Journal of rheumatology. 2009;36(7):PP1387-90.
L. E. Jeffery, K. Raza, M. Hewison, Vitamin D in rheumatoid arthritis-towards clinical application. Nature reviews Rheumatology. 2016;12(4):201-10.
S. I. Taha, S. F. Samaan, R. A. Ibrahim, N. M. Moustafa, E. M. El-Sehsah, M. K Youssef M. K. Can Complete Blood Count Picture Tell Us More About the Activity of Rheumatological Diseases? Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2022; 15: 1179 5441221089182. 10.1177/
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