Patel Sanjeev, Farragher Tracey, Berry Jacqueline, Bunn Diane, Silman Alan, Symmons Deborah
St. Helier University Hospital, Carshalton, London, UK.
Arthritis Rheum. 2007 Jul;56(7):2143-9. doi: 10.1002/art.22722.
Previous in vitro and animal studies have suggested that vitamin D, in particular, its metabolite 25-hydroxyvitamin D (25[OH]D), may have immunomodulatory effects. To study further the potential immunomodulatory effects of vitamin D in humans, we explored the hypothesis that serum vitamin D metabolites may be inversely associated with current disease activity, severity, and functional disability in patients with early inflammatory polyarthritis (IP).
We studied 206 consecutive patients with IP who were enrolled in the Norfolk Arthritis Register between January 2000 and November 2003 inclusive. Patients were studied within 6 months of symptom onset. None of the patients was taking steroids, and all had received <6 weeks of disease-modifying therapy. Associations between serum levels of 25(OH)D and 1,25-dihydroxyvitamin D (1,25OHD) at baseline and the swollen and tender joint counts, Health Assessment Questionnaire (HAQ) scores, C-reactive protein (CRP) levels, and the Disease Activity Score 28-joint assessment (DAS28) scores at baseline and 1 year were assessed.
The median age at symptom onset was 59 years (range 20-88 years), with a median disease duration of 4 months. At baseline, there was an inverse relationship between 25(OH)D levels and the tender joint count, DAS28 score, and HAQ score. The only inverse relationship with 1,25(OH)(2)D was with the HAQ score. Each 10-ng/ml increase in the level of 25(OH)D was associated with a decrease in the DAS28 score of 0.3 and in the CRP level of approximately 25%. At 1 year, the only significant result was an inverse association between baseline vitamin D metabolite levels and the HAQ score; that is, those with higher metabolite levels had lower HAQ scores.
These data provide further support that vitamin D plays an immunomodulatory role in inflammatory arthritis. This association needs to be examined in other cohorts of patients with early IP, as well as in longitudinal studies. If confirmed, the clinical response to vitamin D supplementation should be examined in early IP.
以往的体外和动物研究表明，维生素D，尤其是其代谢产物25-羟基维生素D（25[OH]D），可能具有免疫调节作用。为了进一步研究维生素D在人体中的潜在免疫调节作用，我们探讨了血清维生素D代谢产物可能与早期炎症性多关节炎（IP）患者当前的疾病活动度、严重程度和功能残疾呈负相关的假设。
我们研究了2000年1月至2003年11月（含）期间纳入诺福克关节炎登记处的206例连续的IP患者。在症状出现后的6个月内对患者进行研究。所有患者均未服用类固醇，且均接受了少于6周的改善病情治疗。评估基线时血清25(OH)D和1,25-二羟基维生素D（1,25OHD）水平与肿胀和压痛关节计数、健康评估问卷（HAQ）评分、C反应蛋白（CRP）水平以及基线和1年时的28关节疾病活动评分（DAS28）之间的关联。
症状出现时的中位年龄为59岁（范围20-88岁），中位病程为4个月。在基线时，25(OH)D水平与压痛关节计数、DAS28评分和HAQ评分之间存在负相关。与1,25(OH)(2)D唯一的负相关是与HAQ评分。25(OH)D水平每升高10 ng/ml，DAS28评分降低0.3，CRP水平降低约25%。在1年时，唯一显著的结果是基线维生素D代谢产物水平与HAQ评分之间呈负相关；也就是说，代谢产物水平较高的患者HAQ评分较低。
这些数据进一步支持维生素D在炎症性关节炎中起免疫调节作用。这种关联需要在其他早期IP患者队列以及纵向研究中进行检验。如果得到证实，应在早期IP中研究补充维生素D的临床反应。
