|Price, Lori Lyn|
Submitted to: Rheumatology International
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/10/2011
Publication Date: 12/1/2012
Citation: Pelajo, C.F., Lopez-Benitez, J., Kent, D.M., Price, L., Miller, L.C., Dawson-Hughes, B. 2012. 25-hydroxyvitamin D levels and juvenile idiopathic arthritis: is there an association with disease activity?. Rheumatology International. 32:3923-3929. Interpretive Summary: Vitamin D plays an important role in the immune system and has multiple immunosuppressant properties. Low levels of vitamin D have been associated with a higher incidence of several autoimmune diseases. This study was done to determine whether the circulating level of vitamin D was associated with disease activity in children with juvenile rheumatoid arthritis (JRA). One hundred and fifty four children with a diagnosis of JRA participated in this cross-sectional study. Each participant had vitamin D measured and disease activity assessed using an established scoring system that includes the number of joints involved and other features of disease activity. The average age of participants was 10.6 years. Vitamin D deficiency was detected in 13% and insufficiency in 42%. Vitamin D levels were not associated with disease activity; however, in the subset with new onset arthritis(n=27), there was no significant relationship between vitamin D and disease activity. In conclusion, more than half of the Juvenile Idiopathic Arthritis (JIA) patients in this study had vitamin D levels below 30 ng/ml, the level often considered optimal. There was no association between vitamin D level and disease activity. Larger, longer-term studies with new-onset JIA patients are needed to further explore the association between Vitamin D levels and disease activity.
Technical Abstract: To examine the association between serum levels of 25-hydroxyvitamin D [25(OH)D] and disease activity in juvenile idiopathic arthritis (JIA), to determine the prevalence of vitamin D (VD) deficiency [25(OH)D=19 ng/ml] and insufficiency [25(OH)D 20-29 ng/ml], and to determine factors associated with lower serum levels of 25(OH)D in this population. In this cross-sectional study, disease activity was measured using JADAS-27, as well as its individual components (physician global assessment of disease activity, parent global assessment of child’s well-being, count of joints with active disease, and erythrocyte sedimentation rate). Linear regression models were developed to analyze the association between serum 25(OH)D levels and JADAS-27, and to determine variables associated with serum 25(OH)D levels. 154 patients (61% females, 88% whites) were included. Mean age was 10.6. VD deficiency was detected in 13% and insufficiency in 42%. In univariate and multivariate analyses, 25(OH)D levels were not associated with JADAS-27, neither with its individual components. However, in a subset analysis including all new onset JIA patients (n=27) there was a non-significant negative correlation between serum 25(OH)D levels and JADAS-27 (r=-0.29, p=0.14). In the univariate and multivariate analyses, age, ethnicity, BMI, and season were significantly associated with serum 25(OH)D levels, but not total VD intake. More than 1/2 of JIA patients had serum 25(OH)D levels below 29 ng/ml, however there was no association between serum 25(OH)D levels and disease activity. Future larger, long-term studies with new-onset JIA patients are needed to further explore the association between serum 25(OH)D levels and disease activity.