Gaël Mouterde1, Etienne Gamon2, Nathalie Rincheval3, Cédric Lukas2, Raphaele Seror4, Francis Berenbaum5, Anne-Marie Dupuy6, Claire Daien2, Jean-Pierre Daurès3, Bernard Combe2. 1. G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier; g-mouterde@chu-montpellier.fr. 2. G. Mouterde, MD, E. Gamon, MD, Cedric Lukas, MD, PhD, C. Daien, MD, Bernard Combe, MD, PhD, Rheumatology Department, CHU Montpellier, University of Montpellier, Montpellier. 3. N. Rincheval, J.P. Daurès, MD, PhD, Biostatistics, University Institute of Clinical Research, EA 2415, Montpellier. 4. R. Seror, MD, PhD, Rheumatology, Hôpital Kremlin Bicêtre, Paris. 5. F. Berenbaum, MD, PhD, Sorbonne Université, INSERM, DHU i2B, AP-HP, Hôpital Saint-Antoine, F-75012, Paris. 6. A.M. Dupuy, MD, Department of Biochemistry, CHU Montpellier, Montpellier, France.
Abstract
OBJECTIVE: To evaluate the association of baseline serum level of vitamin D with disease activity, disability, and radiographic damage over the first year in early rheumatoid arthritis (RA). METHODS: Among early arthritis patients included in the ESPOIR cohort, patients with early RA were evaluated. Levels of 25-hydroxy vitamin D2 and D3 were measured at baseline. Baseline associations between vitamin D level and 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), and van der Heijde modified total Sharp score (mTSS) were assessed. Bivariate analysis was used to assess the association between vitamin D level and radiographic progression (mTSS increased by ≥ 1 point) or disability (HAQ-DI ≥ 0.5) over 12 months. Forward stepwise multiple logistic regression was used to evaluate the independent association of baseline variables and outcomes. RESULTS: Among 813 patients with early arthritis, data for 645 patients with RA were analyzed. Vitamin D level was < 10 ng/mL (deficiency, group 1), 10-29.9 ng/mL (low level, group 2), and ≥ 30 ng/mL (normal, group 3) for 114 (17.7%), 415 (64.54%), and 114 (17.7%) patients, respectively. At baseline, DAS28-ESR and HAQ-DI were higher with vitamin D deficiency compared with groups 2 and 3 combined (P = 0.007 and P = 0.001, respectively), as was mean mTSS, but not significantly (p = 0.076). On multivariate analysis, baseline vitamin D deficiency was associated with HAQ-DI at 6 months (OR 1.70) and mTSS at 12 months (OR 1.76). CONCLUSION: Vitamin D deficiency was associated with more active and severe disease at baseline and may predict disability and radiographic progression over 1 year in early RA patients. [ClinicalTrials.gov: NCT03666091].
OBJECTIVE: To evaluate the association of baseline serum level of vitamin D with disease activity, disability, and radiographic damage over the first year in early rheumatoid arthritis (RA). METHODS: Among early arthritispatients included in the ESPOIR cohort, patients with early RA were evaluated. Levels of 25-hydroxy vitamin D2 and D3 were measured at baseline. Baseline associations between vitamin D level and 28-joint count Disease Activity Score based on erythrocyte sedimentation rate (DAS28-ESR), Health Assessment Questionnaire-Disability Index (HAQ-DI), and van der Heijde modified total Sharp score (mTSS) were assessed. Bivariate analysis was used to assess the association between vitamin D level and radiographic progression (mTSS increased by ≥ 1 point) or disability (HAQ-DI ≥ 0.5) over 12 months. Forward stepwise multiple logistic regression was used to evaluate the independent association of baseline variables and outcomes. RESULTS: Among 813 patients with early arthritis, data for 645 patients with RA were analyzed. Vitamin D level was < 10 ng/mL (deficiency, group 1), 10-29.9 ng/mL (low level, group 2), and ≥ 30 ng/mL (normal, group 3) for 114 (17.7%), 415 (64.54%), and 114 (17.7%) patients, respectively. At baseline, DAS28-ESR and HAQ-DI were higher with vitamin D deficiency compared with groups 2 and 3 combined (P = 0.007 and P = 0.001, respectively), as was mean mTSS, but not significantly (p = 0.076). On multivariate analysis, baseline vitamin D deficiency was associated with HAQ-DI at 6 months (OR 1.70) and mTSS at 12 months (OR 1.76). CONCLUSION:Vitamin D deficiency was associated with more active and severe disease at baseline and may predict disability and radiographic progression over 1 year in early RApatients. [ClinicalTrials.gov: NCT03666091].
Entities:
Keywords:
disability; disease activity; early arthritis; rheumatoid arthritis; severity; vitamin D