Rheumatoid arthritis (RA) is a long-term inflammatory disease that affects not just the joints but many other tissues and organs. The process involves an inflammatory response to the lining of the joints causing swelling and inflammation. The disease process often leads to the destruction of cartilage of the joints. Rheumatoid arthritis can also cause inflammation in the lungs, the eyes, the heart, the lungs and lumps under the skin.
Although the cause of rheumatoid arthritis is unknown, autoimmunity plays a pivotal role. About one percent of the world’s population has it, mostly women. Onset is most frequent in the 40s, but people of any age are at risk. There is no cure but some drugs help control the inflammation. Once RA destroys the joint, the destruction is permanent.
Patients with rheumatoid arthritis are at an up to three fold increased risk of cardiovascular disease, but no one knows why. Last month, researchers at John Hopkins’s School of Medicine made the case that it might be vitamin D deficiency leading to the increased cardiovascular disease risk. They also wanted to know if swelling and pain was less in those with high vitamin D levels?
Haque UJ, Bathon JM, Giles JT. Association of vitamin D with cardiometabolic risk factors in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012 May 3. doi: 10.1002/acr.21715. [Epub ahead of print]
Dr. Uzma J. Haque and colleagues studied 179 patients, 168 of which met inclusion criteria, for 20 months to see which ones developed risk factors for cardiovascular disease, measuring vitamin D and its relation to numerous risk factors such as C-reactive protein (CRP), fibrinogen, homocysteine, E-selectin, adiponectin, resistin, leptin, PAI-1 , s-ICAM-1, and HDL.
Among 179 RA patients, 41% had a 25(OH)D level <30ng/mL, while 13% had a 25(OH)D level ≥45ng/mL. For RA characteristics, those with deficient 25(OH)D levels were more likely to have antibodies compared to those with 25(OH)D levels ≥ 45 ng/mL, with those deficient in vitamin D with more swollen and tender joint counts. That is, those with levels above 45 ng/ml suffered less.
Virtually all the risk factors were associated with vitamin D deficiency in the unadjusted models. However, when they adjusted for weight and season of the year (overcorrection in my opinion), the authors “observed a significant cross-sectional association between lower vitamin D levels and several cardiometabolic risk factors in a cohort of RA patients. Specifically, 25(OH)D had a significant inverse association with E-selectin and s-ICAM and a positive association with HDL even after adjusting for several potential confounders, including RA disease activity. These findings are novel and this is the first report implicating vitamin D deficiency as a possible cardiometabolic risk factor in RA.”
At least one cardiovascular risk factor (I-CAM) kept getting better the higher the vitamin D levels, the lower the I-CAM, while the other two had cutoffs around 30 ng/ml. The authors reported, “These preliminary findings may have broad clinical implications in management of RA.”
My opinion is if you have RA, take 5,000 IU/day to get your vitamin D levels up to at least 50 ng/ml and do it sooner rather than later.