Recentemente si è osservato che la vitamina D svolge un ruolo importante nella regolazione della risposta immune. Molte cellule del sistema immunnitario esprimono i recettori della vitamina D. Studi in vitro e in vivo hanno mostrato che i metabolici della vitamina D modulano la proliferazione dei linfociti T e l’attività delle cellule dendritiche. Inoltre dati epidemiologici mostrano che la carenza di vitamina D si associa ad un aumentato rischio di sviluppare malattie autoimmuni. La carenza di vitamina D è piuttosto frequente tra la popolazione anziana e si associa a sintomi muscoloscheletrici. Nell’ artite reumatoide la sua carenza parrebbe associarsi ad un aumentato rischio di disabilità e ad un aumentata attività di malattia. Abbiamo studiato 1191 pazienti affetti da AR (85% donne) provenienti da 22 Centri reumatologici italiani. Sono stati eseguiti dosaggi centralizzati della 25 OH vitamina D e del PTH, sono stati valutati i parametri di attività di malattia, lo stato funzionale di malattia, il tempo di esposizione al sole. Il 55% dei pazienti non assumevano supplementi di vitamina D, tra questi il 52% avevano livelli vitaminici D < 20 ng/ml e tra i pazienti che ricevevano vitamina D 1/3 aveva livelli vitaminici < 20 ng/ml. I livelli 25 OH vit D si correlavano significativamente con l’ Health Assessment Questionnaire Disability Index (HAQ), con il Mobility Activities of daily living score (ADL) e con il numero di articolazioni tumefatte. I pazienti non in remissione e scarsamente responsivi alla terapia di fondo avevano livelli significativamente più bassi di 25 (OH)vitD ed appartenevano alle classi funzionali di Steinbroker più elevate. Il BMI e l’esposizione solare erano i migliori predittori dei livelli vitaminici D. I pazienti con malattia più grave erano quelli che passavano meno tempo al sole. L’associazione tra attività di malattia, score funzionale e livelli di vitamina D rimanevano statisticamente significativi anche dopo correzione per il BMI e per l’esposizione solare. Si è osservata una correlazione tra densità minerale ossea ed erosioni. Si è osservato inoltre una correlazione indipendente tra livelli sierici di PTH e presenza di erosioni non associata alla deficienza di vitaminaD. In conclusione, nei pazienti affetti da AR vi è una forte correlazione inversa tra attività di malattia, disabilità e livelli sierici di 25(OH)vitaminaD che rimane significativa anche dopo correzione per BMD ed esposizione solare. Le cause di queste associazioni andranno indagate in studi longitudinali mirati a valutare la risposta clinica alla somministrazione di supplementi di vitamina D.
Emerging evidence suggests that vitamin D plays an important role in immune regulation. Vitamin D receptors are found on several immune cells and in vitro studies have shown that vitamin D metabolites modulate T cell proliferation and dendritic cell function. Epidemiological data also imply that vitamin D deficiency may be a risk for development of autoimmune and other chronic diseases. Preliminary studies suggest that low levels of vitamin D may be common in rheumatoid arthritis (RA).It was reported an inverse relationship between vitamin D levels and disease activity and disability in patients with early inflammatory polyarthritis. Vitamin D deficiency is quite common among elderly individuals and it is associated with musculoskeletal symptoms. In rheumatoid arthritis (RA), its deficiency may be associated with increased disease activity and disability. We studied 1191 consecutive RA patients (85% women) from 22 Italian rheumatology centres. Together with parameters of disease activity, functional impairment, and mean time spent outdoor during summer months (sun exposure time), all patients had serum 25-hydroxyvitamin D [25(OH)D] and serum parathyroid hormone (PTH) levels measured in a centralized laboratory. Fifty five % of patients were not taking vitamin D supplements; the proportion of these patients with 25(OH)D level <20 ng/ml was 52%, and one third of those supplemented. In non-supplemented patients 25(OH)D levels were significantly correlated with Health Assessment Questionnaire Disability Index (HAQ), Mobility Activities of daily living score (ADL) , number of swollen joints. Significantly lower 25(OH)D values were found in patients not on disease remission or poorly responding to treatment, with the highest Steinbrocker functional state, and treated with disease-modifying antirheumatic drugs (DMARD). Body mass index (BMI) and sun exposure time were good predictors of 25(OH)D values (p>0.000). The patients with the worse indices of disease activity were spending significantly less time at sunshine. The association between disease activity scores or functional sores and 25(OH)D levels remained statistically significant even adjusting 25(OH)D levels for both sun exposure time and BMI. In conclusion, in RA patients disease activity and disability scores are inversely related with 25(OH)D levels. The causality of these associations must be confirmed by longitudinal studies aimed at evaluating the clinical response of disease activity to large vitamin D supplementations.
Vitamina D e artrite reumatoide
FRACASSI, Elena
2010-01-01
Abstract
Emerging evidence suggests that vitamin D plays an important role in immune regulation. Vitamin D receptors are found on several immune cells and in vitro studies have shown that vitamin D metabolites modulate T cell proliferation and dendritic cell function. Epidemiological data also imply that vitamin D deficiency may be a risk for development of autoimmune and other chronic diseases. Preliminary studies suggest that low levels of vitamin D may be common in rheumatoid arthritis (RA).It was reported an inverse relationship between vitamin D levels and disease activity and disability in patients with early inflammatory polyarthritis. Vitamin D deficiency is quite common among elderly individuals and it is associated with musculoskeletal symptoms. In rheumatoid arthritis (RA), its deficiency may be associated with increased disease activity and disability. We studied 1191 consecutive RA patients (85% women) from 22 Italian rheumatology centres. Together with parameters of disease activity, functional impairment, and mean time spent outdoor during summer months (sun exposure time), all patients had serum 25-hydroxyvitamin D [25(OH)D] and serum parathyroid hormone (PTH) levels measured in a centralized laboratory. Fifty five % of patients were not taking vitamin D supplements; the proportion of these patients with 25(OH)D level <20 ng/ml was 52%, and one third of those supplemented. In non-supplemented patients 25(OH)D levels were significantly correlated with Health Assessment Questionnaire Disability Index (HAQ), Mobility Activities of daily living score (ADL) , number of swollen joints. Significantly lower 25(OH)D values were found in patients not on disease remission or poorly responding to treatment, with the highest Steinbrocker functional state, and treated with disease-modifying antirheumatic drugs (DMARD). Body mass index (BMI) and sun exposure time were good predictors of 25(OH)D values (p>0.000). The patients with the worse indices of disease activity were spending significantly less time at sunshine. The association between disease activity scores or functional sores and 25(OH)D levels remained statistically significant even adjusting 25(OH)D levels for both sun exposure time and BMI. In conclusion, in RA patients disease activity and disability scores are inversely related with 25(OH)D levels. The causality of these associations must be confirmed by longitudinal studies aimed at evaluating the clinical response of disease activity to large vitamin D supplementations.File | Dimensione | Formato | |
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