Preventive and Clinical Nutrition Group, Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark.
Indigenous Global Health Research Group, Department of Medicine, College of Health Sciences, University of Alberta, Edmonton, Canada.
Nutr Rev. 2024 Apr 12;82(5):600-611. doi: 10.1093/nutrit/nuad083.
Rheumatoid arthritis is a chronic inflammatory disease that causes synovitis. Vitamin D deficiency is common in rheumatoid arthritis.
This systematic review and meta-analysis investigated whether vitamin D supplementation affects the inflammatory and clinical outcomes in patients with rheumatoid arthritis on the basis of randomized clinical trials.
A literature search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, MEDLINE, Embase, and Google Scholar for articles published until May 2022.
The studies were selected according to PRISMA guidelines, and the risk of bias was assessed for randomized controlled trials.
A random effects model was used to conduct a meta-analysis, and heterogeneity was assessed using the I2 statistic. Of 464 records, 11 studies were included from 3049 patients. Conclusion: Vitamin D supplementation did not significantly reduce C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), disease activity score in 28 joints (DAS28), or the health assessment questionnaire score; however, the response to supplementation was highly heterogeneous. The pooled analysis showed that vitamin D significantly reduced the pain-visual analogue scale (VAS) weighted mean difference (WMD = -1.30, 95% confidence interval [CI] [-2.34, -27], P = .01), DAS28-CRP (WMD = -.58, 95% CI [-.86, -.31], P < .0001), and DAS28-ESR (WMD = -.58, 95% CI [-.86, -.31], P = .0001). Subgroup analysis for vitamin D doses (>100 µg per day versus <100 µg per day) showed that the higher doses had a more significant effect on CRP than the lower doses (P < .05).
There was no significant difference between the effect of 2 vitamin D doses on ESR and DAS28. To minimize the high heterogeneity among studies in this meta-analysis, other confounding factors such as baseline vitamin D, age, dietary vitamin D, time of year, sun exposure, drug interaction, effect dosage, and power of study should be examined.
类风湿关节炎是一种慢性炎症性疾病，可导致滑膜炎。类风湿关节炎患者中维生素 D 缺乏很常见。
本系统评价和荟萃分析旨在根据随机临床试验调查维生素 D 补充是否会影响类风湿关节炎患者的炎症和临床结局。
对 Cochrane 对照试验中心注册库（CENTRAL）、PubMed、MEDLINE、Embase 和 Google Scholar 进行了文献检索，检索时间截至 2022 年 5 月。
根据 PRISMA 指南选择研究，并对随机对照试验进行偏倚风险评估。
使用随机效应模型进行荟萃分析，并使用 I2 统计量评估异质性。在 464 条记录中，从 3049 名患者中纳入了 11 项研究。结论：维生素 D 补充并未显著降低 C 反应蛋白（CRP）、红细胞沉降率（ESR）、28 个关节疾病活动评分（DAS28）或健康评估问卷评分；然而，补充反应具有高度异质性。汇总分析显示，维生素 D 可显著降低疼痛视觉模拟量表（VAS）的加权均数差（WMD=-1.30，95%置信区间[-2.34，-27]，P=0.01）、DAS28-CRP（WMD=-0.58，95%置信区间[-0.86，-0.31]，P<0.0001）和 DAS28-ESR（WMD=-0.58，95%置信区间[-0.86，-0.31]，P=0.0001）。维生素 D 剂量（>100μg/天与<100μg/天）的亚组分析表明，较高剂量对 CRP 的影响大于较低剂量（P<0.05）。
两种维生素 D 剂量对 ESR 和 DAS28 的影响无显著差异。为了最大限度地减少本荟萃分析中研究之间的高度异质性，应检查其他混杂因素，如基线维生素 D、年龄、饮食维生素 D、一年中的时间、阳光照射、药物相互作用、作用剂量和研究能力。
