Letter to the Editor
Vitamin D and Autoimmune Rheumatic Diseases
Vitamina D y enfermedades reumáticas
María A. Martín-Martíneza, Santos Castañedab, Ana Urruticoechea-Aranac, Miguel A. González-Gayd,e,
Corresponding author
a Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
b Servicio de Reumatología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
c Sección de Reumatología, Hospital Can Misses, Ibiza, Balearic Islands, Spain
d Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain
e Grupo de Investigación en Epidemiología, Genética y Aterosclerosis de las Enfermedades Inflamatorias Sistémicas, Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Santander, Cantabria, Spain
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Martín-Martínez, Santos Castañeda, Ana Urruticoechea-Arana, Miguel A. González-Gay" "autores" => array:4 [ 0 => array:3 [ "nombre" => "María A." "apellidos" => "Martín-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Santos" "apellidos" => "Castañeda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana" "apellidos" => "Urruticoechea-Arana" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:4 [ "nombre" => "Miguel A." "apellidos" => "González-Gay" "email" => array:1 [ 0 => "miguelaggay@hotmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Sección de Reumatología, Hospital Can Misses, Ibiza, Balearic Islands, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Cantabria, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Grupo de Investigación en Epidemiología, Genética y Aterosclerosis de las Enfermedades Inflamatorias Sistémicas, Instituto de Investigación Sanitaria Marqués de Valdecilla (IDIVAL), Santander, Cantabria, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vitamina D y enfermedades reumáticas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We were highly interested in the editorial “<span class="elsevierStyleItalic">Vitamina D y enfermedades autoinmunes reumáticas</span>” (“Vitamin D and autoimmune rheumatic disease”), published recently in <span class="elsevierStyleSmallCaps">Reumatología Clínica</span>.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> At the present time, it is well-known that vitamin/hormone D has an essential role in the regulation of the immune system,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and that its deficiency is related to the presence of inflammation, autoimmunity, cancer and atherosclerosis.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This is especially interesting, when we learn that the levels of vitamin D are substantially reduced in western countries and in the Spanish population in particular.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">As the authors of the editorial do point out, the deficiency or insufficiency of vitamin D is related not only to the coexistence of autoimmune diseases like systemic lupus erythematosus or rheumatoid arthritis (RA), but also to the activity of some of these diseases.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5–7</span></a> The role that vitamin/hormone D may have in other chronic inflammatory diseases, like ankylosing spondylitis (AS) or psoriatic arthritis (PsA), is less well-known.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recently, we published the baseline data on cardiovascular morbidity and levels of vitamin/hormone D in patients included in the CARMA (“CARdiovascular in rheuMAtology”) project.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a> The proposal is a prospective Spanish study, promoted by the Sociedad Española de Reumatología (SER), in which we evaluate the risk of developing a fatal cardiovascular event after 10 years in patients with RA, AS and PsA, compared to a cohort of patients with no inflammatory diseases, followed in rheumatology clinics of 67 Spanish hospitals. The study includes a total of 2234 patients: 775 RA, 738 AS and 721 PsA, in addition to 677 noninflammatory individuals, with degenerative or soft tissue diseases.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In the baseline analysis, we found that the patients with inflammatory diseases had a more marked deficiency of D (25-OH-vitamin D<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>20<span class="elsevierStyleHsp" style=""></span>ng/mL), than the noninflammatory patients (40.5% in RA; 40% in AS; 41% in PsA; and 26.7% in the control group; [<span class="elsevierStyleItalic">P</span><.001]). The mean levels of 25-OH-vitamin D were: 20.4<span class="elsevierStyleHsp" style=""></span>ng/mL in RA; 20.9<span class="elsevierStyleHsp" style=""></span>ng/mL in AS; 20<span class="elsevierStyleHsp" style=""></span>ng/mL in PsA; and 24.8<span class="elsevierStyleHsp" style=""></span>ng/mL in the control group. We should point out that the controls included, mostly, patients with osteoarthritis, osteoporosis, low back pain or soft tissue disease, in which vitamin/hormone D is usually reduced, as we confirmed, although with fewer percentage points of deficiency.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">With respect to the activity and severity, the bivariate study demonstrated a significant association between the vitamin/hormone D deficiency and certain parameters for aggressive disease. This association disappeared in the adjusted model, although there persisted a certain associative trend between the vitamin/hormone D deficiency and the presence of anti-cyclic citrullinated peptide antibodies (adjusted odds ratio [OR]: 1.45; 95% confidence interval [CI]: 0.99–2.12; <span class="elsevierStyleItalic">P</span>=.056) and Bath AS Functional Index (adjusted OR: 1.08; 95% CI: 0.99–1.17; <span class="elsevierStyleItalic">P</span>=.070)<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> in RA and AS, respectively. However, we also point out that patients with inflammatory diseases are closely controlled in hospital rheumatology units, and between 40% and 47.4% are receiving biologic therapy, with activity reduced to their inclusion in the study (disease activity score 28 joints–erythrocyte sedimentation rate of 3.2 in RA and 3.0 in PsA; Bath AS Disease Activity Index 3.5 in AS).<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Although our work has certain limitations and there are still doubts concerning supplementation in patients with vitamin/hormone D deficiency, in particular, those with chronic inflammatory diseases, as to, whether, it improves their health and reduces inflammatory activity.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> We feel, like the authors of the editorial, that it is important to monitor and supplement these patients, especially those with a moderate/serious deficiency, because of the possible pathogenic role that vitamin/hormone D may have in the course and comorbidity of their underlying disease.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, it must still be determined whether the maintenance of low vitamin D levels increments the incident of cardiovascular events in our cohort. This is one of the objectives of the CARMA study, and is to be analyzed in the next few years.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín-Martínez MA, Castañeda S, Urruticoechea-Arana A, González-Gay MA. Vitamina D y enfermedades reumáticas. Reumatol Clin. 2016;12:356–357.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vitamina D y enfermedades autoinmunes reumáticas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. García-Carrasco" 1 => "J.L. 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Ioannidis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "348" "paginaInicial" => "g2035" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24690624" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack250159" "titulo" => "Acknowledgements" "texto" => "<p id="par0040" class="elsevierStylePara elsevierViewall">All of the patients and participating centers, whose role in the follow-up and collection of clinical data is being fundamental for the development of the project. The list of participating centers and authors appears in the addendum of the respective publications. Likewise, we wish to thank the SER and Abbvie España for promoting and sponsoring the project.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001200000006/v1_201611050033/S2173574316300946/v1_201611050033/en/main.assets" "Apartado" => array:4 [ "identificador" => "8400" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001200000006/v1_201611050033/S2173574316300946/v1_201611050033/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574316300946?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 11 | 15 | 26 |
| 2024 October | 38 | 23 | 61 |
| 2024 September | 32 | 13 | 45 |
| 2024 August | 47 | 26 | 73 |
| 2024 July | 31 | 25 | 56 |
| 2024 June | 40 | 24 | 64 |
| 2024 May | 37 | 22 | 59 |
| 2024 April | 39 | 17 | 56 |
| 2024 March | 51 | 23 | 74 |
| 2024 February | 24 | 21 | 45 |
| 2024 January | 21 | 15 | 36 |
| 2023 December | 22 | 22 | 44 |
| 2023 November | 39 | 20 | 59 |
| 2023 October | 32 | 26 | 58 |
| 2023 September | 59 | 34 | 93 |
| 2023 August | 25 | 9 | 34 |
| 2023 July | 25 | 22 | 47 |
| 2023 June | 31 | 26 | 57 |
| 2023 May | 32 | 21 | 53 |
| 2023 April | 14 | 15 | 29 |
| 2023 March | 44 | 35 | 79 |
| 2023 February | 44 | 28 | 72 |
| 2023 January | 22 | 8 | 30 |
| 2022 December | 49 | 39 | 88 |
| 2022 November | 68 | 30 | 98 |
| 2022 October | 48 | 21 | 69 |
| 2022 September | 62 | 43 | 105 |
| 2022 August | 47 | 42 | 89 |
| 2022 July | 30 | 42 | 72 |
| 2022 June | 22 | 33 | 55 |
| 2022 May | 27 | 35 | 62 |
| 2022 April | 26 | 44 | 70 |
| 2022 March | 24 | 35 | 59 |
| 2022 February | 29 | 29 | 58 |
| 2022 January | 17 | 32 | 49 |
| 2021 December | 20 | 36 | 56 |
| 2021 November | 32 | 43 | 75 |
| 2021 October | 33 | 63 | 96 |
| 2021 September | 27 | 42 | 69 |
| 2021 August | 23 | 46 | 69 |
| 2021 July | 22 | 28 | 50 |
| 2021 June | 24 | 22 | 46 |
| 2021 May | 28 | 43 | 71 |
| 2021 April | 73 | 90 | 163 |
| 2021 March | 52 | 27 | 79 |
| 2021 February | 28 | 26 | 54 |
| 2021 January | 25 | 18 | 43 |
| 2020 December | 26 | 24 | 50 |
| 2020 November | 51 | 18 | 69 |
| 2020 October | 52 | 15 | 67 |
| 2020 September | 31 | 26 | 57 |
| 2020 August | 23 | 22 | 45 |
| 2020 July | 30 | 17 | 47 |
| 2020 June | 28 | 32 | 60 |
| 2020 May | 27 | 18 | 45 |
| 2020 April | 25 | 29 | 54 |
| 2020 March | 11 | 2 | 13 |
| 2020 February | 2 | 0 | 2 |
| 2020 January | 1 | 0 | 1 |
| 2018 May | 4 | 3 | 7 |
| 2018 April | 31 | 6 | 37 |
| 2018 March | 33 | 7 | 40 |
| 2018 February | 24 | 5 | 29 |
| 2018 January | 20 | 3 | 23 |
| 2017 December | 22 | 6 | 28 |
| 2017 November | 21 | 7 | 28 |
| 2017 October | 21 | 2 | 23 |
| 2017 September | 23 | 7 | 30 |
| 2017 August | 20 | 6 | 26 |
| 2017 July | 36 | 14 | 50 |
| 2017 June | 44 | 27 | 71 |
| 2017 May | 44 | 19 | 63 |
| 2017 April | 37 | 17 | 54 |
| 2017 March | 28 | 14 | 42 |
| 2017 February | 20 | 16 | 36 |
| 2017 January | 60 | 31 | 91 |
| 2016 December | 71 | 43 | 114 |
| 2016 November | 48 | 39 | 87 |
| 2016 October | 4 | 3 | 7 |
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