Vitamin D Status among Rheumatoid Arthritis Patients Attending Benghazi Medical Centre Rheumatoid Out-patients Clinic: A Cross-sectional Study
Faiza Nouh
*
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Salima Elfagi
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Mohammed H. Buzgeia
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Mohamed F. Madi
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Ghazalla Farag
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Ebtehal Yousef
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
Sondos Abbas
Department of Nutrition, Faculty of Public Health, University of Benghazi, Libya.
*Author to whom correspondence should be addressed.
Abstract
Rheumatoid arthritis is an autoimmune inflammatory disorder. Vitamin D deficiency has been linked to the occurrence of autoimmune illnesses such multiple sclerosis and type one diabetes millets. This study aims to evaluate the vitamin D status in RA patients, as well as the link between vitamin D levels and disease activity. The current study is a cross-sectional study carried on rheumatoid arthritis patients who attend Benghazi Medical Centre (BMC) rheumatoid clinic. The sample includes all age groups of RA patients who had a recent serum vitamin D test results giving aresponse rate of 95 %. The study consists of 248 patients, 39 (15.7%) are male and the remaining 209 (84.3%) are female. The overall mean ± standard deviation of age for men and women was in the range of 53 ± 4. 24% of patients had normal vitamin D levels, while 36% and 40% of patients had insufficiency and deficiency in vitamin D, respectively. Gender and marriage status were the only socio-economic factors associated with the subject's vitamin D status (p <0.05). Body mass index was a nutritional factor associated with a subject's vitamin D status (p <0.05) in RA patients. It is recommended that all RA patients have serum vitamin D as routine test.
Keywords: Vitamin D status, rheumatoid arthritis, supplement, nutrition
How to Cite
Downloads
References
Elfagi S. Bushofa E, Nouh F, Elkarghali N, Shaheen H, Alhoni A, Omar M, Eltuhami A. Study the relationship between Omega-3 dietary intake and rheumatoid arthritis. Scholar Academic Journal of Pharmcy. 2021;8:128-38.
Aletaha D, Smolen JS. Diagnosis and management of rheumatoid arthritis. A review. Journal of the American Medical Association. 2018;320(13):1360-72.
Lin YJ, Anzaghe M, Schülke S. Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells. 2020;9(4):880.
Otón T, Carmona L. The epidemiology of established rheumatoid arthritis. Best Practice and Research Clinical Rheumatology. 2019;33(5):101477.
Myasoedova E, Davis J, Matteson EL, Crowson CS. Is the epidemiology of rheumatoid arthritis changing? Results from a population-based incidence study, 1985–2014. Annals of the rheumatic diseases. 2020;79(4):440-444.
Volkov M, van Schie KA, van der Woude D. Autoantibodies and B Cells: The ABC of rheumatoid arthritis pathophysiology. Immunological reviews. 2020;294(1): 148-163.
Rocha SD, Baldo DC, Andrade LE. Clinical and pathophysiologic relevance of autoantibodies in rheumatoid arthritis. Advances in Rheumatology. 2019;2(1): 29;59.
Evangelatos G, Fragoulis GE, Koulouri V, Lambrou GI. MicroRNAs in rheumatoid arthritis: From pathogenesis to clinical impact. Autoimmunity Reviews. 2019; 18(11):102391.
van der Woude D, van der Helm-van AH. Update on the epidemiology, risk factors, and disease outcomes of rheumatoid arthritis. Best practice and research Clinical rheumatology. 2018;32(2):174-87.
Qiao Y, Wang Z, Li Y, Han Y, Zhou Y, Cao X. Rheumatoid arthritis risk in periodontitis patients: a systematic review and meta-analysis. Joint Bone Spine. 2020 Dec 1;87(6):556-64.
Gioia C, Lucchino B, Tarsitano MG, Iannuccelli C, Di Franco M. Dietary habits and nutrition in rheumatoid arthritis: can diet influence disease development and clinical manifestations?. Nutrients. 2020 May;12(5):1456.
Sanlier N, Guney-Coskun M, Vitamin D, the immune system, and its relationship with diseases. Egypt Pediatric Association Gaz. 2022;70(1). Available:https://doi.org/10.1186/s43054-022-00135-w
Harrison SR, Li D, Jeffery LE, Raza K, Hewison M. Vitamin D, autoimmune disease and rheumatoid arthritis. Calcified Tissue international. 2020 Jan;106(1): 58-75.
Omar M, Nouh F, Younis M, Younis M, Nabil N, Saad M, Ali M. Culture, sun exposure and Vitamin D deficiency in Benghazi, Libya. Journal of Advance Medical Research. 2018;25(5):1-3.
Omar M, Nouh F, Younis M, Younis M, Nabil N, Saad M, Ali M. Vitamin D status and contributing factors in patients attending three polyclinics in Benghazi, Libya. Journal of Advances in Medicine and Medical Research. 2017;24(5): 2231-0614.
Holick M, Binkley N, Bischoff-Ferrari H, Gordon C, Hanley D, Heaney R, Murad H, Weaver C. Evaluation, treatment, and prevention of vitamin D deficiency. An endocrine society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism. 2011;96(7):1911–1930.
Favalli EG, Biggioggero M, Crotti C, Becciolini A, Raimondo MG, Meroni PL. Sex and management of rheumatoid arthritis. Clinical reviews in allergy & immunology. 2019 Jun;56(3):333-45.
Intriago M, Maldonado G, Cárdenas J, Ríos C. Clinical characteristics in patients with rheumatoid arthritis. differences between genders. The Scientific World Journal. 2019 Jul 3;2019.
Craig SM, Yu F, Curtis JR, Alarcon GS, Conn DL, Jonas B, et al. Vitamin D status and its associations with disease activity and severity in African, Americans with recent-onset rheumatoid arthritis. J Rheumatol. 2010;37(2):275–81.
Dupuis ML, Pagano MT, Pierdominici M, Ortona E. The role of vitamin D in autoimmune diseases. could sex make the difference? Biology of sex differences. 2021 Dec;12(1):1-2.
Thambiah SC, Wong TH, Gupta ED, Radhakrishnan AK, Gun SC, Chembalingam G, Lai LC, Yeap SS. Calculation of free and bioavailable vitamin D and its association with bone mineral density in Malaysian women with rheumatoid arthritis. The Malaysian Journal of pathology. 2018 Dec 1;40(3):287-94.
Omair MA, Erdogan A, Tietz N, Alten R. Physical and emotional burden of rheumatoid arthritis in Saudi Arabia. an exploratory cross-sectional study. Open access rheumatology. research and reviews. 2020;12:337.
Bermas BL, Tucker JS, Winkelman DK, Katz JN. Marital satisfaction in couples with rheumatoid arthritis. Arthritis Care & Research. 2000 Jun;13(3):149-55.
Danoff-Burg S, Revenson TA. Benefit-finding among patients with rheumatoid arthritis. Positive effects on interpersonal relationships. Journal of behavioral medicine. 2005 Feb;28(1):91-103.
Waltz M, Kriegel W, Bosch PV. The social environment and health in rheumatoid arthritis. marital quality predicts individual variability in pain severity. Arthritis & rheumatism. Official Journal of the American College of Rheumatology. 1998 Oct;11(5):356-74.
Reese JB, Somers TJ, Keefe FJ, Mosley-Williams A, Lumley MA. Pain and functioning of rheumatoid arthritis patients based on marital status. is a distressed marriage preferable to no marriage? The Journal of Pain. 2010 Oct 1;11(10): 958-64.
Voight BF, Kang HM, Ding J, Palmer CD, Sidore C, et al. Correction: The metabochip, A custom genotyping array for genetic studies of metabolic, Cardiovascular, and anthropometric traits. PLOS Genetics. 2013;9(4):10.1371.
Philippou E, Nikiphorou E. Are we really what we eat? Nutrition and its role in the onset of rheumatoid arthritis. Autoimmunity reviews. 2018 Nov 1;17(11):1074-7.
Aslam MM, John P, Bhatti A, Jahangir S, Kamboh MI. Vitamin D as a principal factor in mediating rheumatoid arthritis-derived immune response. Biomedical research international. 2019;2(4):1894-1901
Ciobanu DA, Poenariu IS, Crînguș LI, Vreju FA, Turcu-Stiolica A, Tica AA, Padureanu V, Dumitrascu RM, Banicioiu-Covei S, Dinescu SC, Boldeanu L. JAK/STAT pathway in pathology of rheumatoid arthritis. Experimental and Therapeutic Medicine. 2020;20(4): 3498-503.
Deane KD, Holers VM. Rheumatoid arthritis pathogenesis, prediction, and prevention: an emerging paradigm shift. Arthritis and Rheumatology. 2021;73(2): 181-93.
Luo Q, Gao Y, Zhang L, Rao J, Guo Y, Huang Z, Li J. Decreased ALKBH5, FTO, and YTHDF2 in peripheral blood are as risk factors for rheumatoid arthritis. BioMed Research International. 2020;20;2020.
Lee YH, Bae SC. Vitamin D level in rheumatoid arthritis and its correlation with the disease activity: A meta-analysis. Clinical Experimental Rheumatology. 2016;34:827–33
Khajoei S, Hassaninevisi M, Kianmehr N, Seif F, Khoshmirsafa M, Shekarabi M. Serum levels of adiponectin and vitamin D correlate with activity of rheumatoid arthritis. Rheumatology. 2019;46:2505–12.
Heiberg T, Kvien TK. Preferences for improved health examined in 1,024 patients with rheumatoid arthritis. pain has highest priority. Arthritis Rheumatology. 2002;47:391–7.
Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain. Visual analog scale for pain (VAS Pain), Numeric rating scale for pain (NRS Pain), McGill pain questionnaire (MPQ), Short-Form McGill pain questionnaire (SF-MPQ), Chronic pain grade scale (CPGS), Short form-36 bodily pain scale (SF-36 BPS), and measure of intermittent and constant osteoarthritis pain (ICOAP). Arthritis Care Research. 2011;63(Suppl. 11): S240–52.
Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016; 388:2023–38.
Cutolo M, Otsa K, Laas K, Yprus M, Lehtme R, Secchi ME, et al. Circannual vitamin d serum levels and disease activity in rheumatoid arthritis. Northern versus southern europe. Clin Exp Rheumatol. 2006;24(6):702–4.
Attar SM. Vitamin D deficiency in rheumatoid arthritis. Saudi Med J. 2012; 33(5):520-5.
Kriegel MA, Manson JE, Costenbader KH. Does vitamin D affect risk of developing autoimmune disease? a systematic review. Seminars in arthritis and rheumatism. 2011;40(6):512–31.e8
Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44–8.
Bjorkman MP, Sorva AJ, Tilvis RS. C-reactive protein and fibrinogen of bedridden older patients in a six-month vitamin D supplementation trial. Journal of Nutrition Health Aging. 2009;13:435–9.
Moghimi J, Sadeghi A, Malek M, Ghorbani R. Relationship between disease activity and serum levels of vitamin D and parathyroid hormone in rheumatoid arthritis. Endocrine Regulation. 2012;46: 61–6.
Van Riel PL, Renskers L. The disease activity score (DAS) and the disease activity score using 28 joint counts (DAS28) in the management of rheumatoid arthritis. Clin Exp Rheumatol. 2016; 34(Suppl. 101):S40–4.Tabatabaeizadeh
SA, Avan A, Bahrami A, Khodashenas E, Esmaeili H, Ferns GA. High dose supplementation of vitamin D affects measures of systemic inflammation. reductions in high sensitivity C-reactive protein level and neutrophil to lymphocyte ratio (NLR) distribution. J Cell Biochem. 2017; 118:4317–22.
Liu Y, Yan X. Eriodictyol inhibits survival and inflammatory responses and promotes apoptosis in rheumatoid arthritis fibroblast‐like synoviocytes through AKT/FOXO1 signaling. Journal of Cellular Biochemistry. 2019 Sep;120(9):14628-35.