Mukherjee Dibyendu, Lahiry Sandeep, Thakur Sayanta, Chakraborty Dwaipayan Sarathi
Department of General Medicine, KPC Medical College and Hospital, Kolkata, West Bengal, India.
Department of Pharmacology, RG Kar Medical College, Kolkata, West Bengal, India.
J Family Med Prim Care. 2019 Feb;8(2):517-522. doi: 10.4103/jfmpc.jfmpc_446_18.
To assess effect of 1,25 dihydroxy vitamin D3 supplementation on pain relief in early rheumatoid arthritis (RA).
An open-labeled randomized trial was conducted comparing 60,000 IU 1,25 dihydroxy vitamin D3 + calcium (1000 mg/day) combination [Group A] versus calcium (1000 mg/day) only [Group B], as supplement to existing treatment regimen in early RA. Primary outcome included (i) minimum time required for onset of pain relief (Tm) assessed through patients' visual analog scale (VAS); (ii) % change in VAS score from onset of pain relief to end of 8 weeks. Secondary outcome included change in disease activity score (DAS-28).
At the end of 8-weeks, Group A reported 50% higher median pain relief scores (80% vs. 30%; < 0.001) and DAS-28 scores (2.9 ± 0.6 vs. 3.1 ± 0.4; = 0.012) compared to Group B; however, Tm remained comparable (19 ± 2 vs. 20 ± 2 days; = 0.419). Occurrence of hypovitaminosis-D was lower (23.3%) compared to Indian prevalence rates and was a risk factor for developing active disease (Odds Ratio (OR) = 7.52 [95% Confidence Interval (CI) 2.67-21.16], < 0.0001). Vitamin D deficiency was significantly ( < 0.001) more common in female gender, active disease, and shorter mean disease duration. Vitamin D levels were inversely correlated to disease activity as assessed by DAS-28 ( = -0.604; < 0.001).
Vitamin-D deficiency is a risk factor for developing active disease in RA. Weekly supplementation of 60,000 IU of 1,25 dihydroxy vitamin D3 in early RA results in greater pain relief. The number needed to treat for this additional pain relief was 2.
CTRI/2018/01/011532 (www.ctri.nic.in).
评估补充1,25 - 二羟维生素D3对早期类风湿关节炎（RA）疼痛缓解的效果。
开展一项开放标签随机试验，比较60,000 IU 1,25 - 二羟维生素D3与钙（1000毫克/天）联合用药组[甲组]和仅补充钙（1000毫克/天）组[乙组]，作为早期RA现有治疗方案的补充。主要结局包括：（i）通过患者视觉模拟量表（VAS）评估疼痛缓解开始所需的最短时间（Tm）；（ii）从疼痛缓解开始到8周结束时VAS评分的变化百分比。次要结局包括疾病活动评分（DAS - 28）的变化。
8周结束时，与乙组相比，甲组报告的疼痛缓解中位数评分高50%（80%对30%；P<0.001），DAS - 28评分也更高（2.9±0.6对3.1±0.4；P = 0.012）；然而，Tm保持相当（19±2天对20±2天；P = 0.419）。维生素D缺乏症的发生率低于印度患病率（23.3%），并且是发生活动性疾病的一个危险因素（优势比（OR）= 7.52[95%置信区间（CI）2.67 - 21.16]，P<0.0001）。维生素D缺乏在女性性别、活动性疾病和较短的平均病程中显著更常见（P<0.001）。维生素D水平与通过DAS - 28评估的疾病活动呈负相关（r = -0.604；P<0.001）。
维生素D缺乏是RA发生活动性疾病的一个危险因素。早期RA每周补充60,000 IU 1,25 - 二羟维生素D3可带来更大程度的疼痛缓解。为获得这种额外的疼痛缓解所需治疗的人数为2。
CTRI/2018/01/011532（www.ctri.nic.in）
