ORIGINAL PAPER
Vitamin D level in children with juvenile idiopathic arthritis and its correlation with clinical picture of the disease
Submission date: 2013-04-20
Final revision date: 2013-06-25
Acceptance date: 2013-07-26
Online publication date: 2013-09-11
Publication date: 2013-08-30
Reumatologia 2013;51(4):271-276
KEYWORDS
TOPICS
Rheumatoid arthritis- aetiology, pathogenesis, clinical features and treatmentAssessment of disease activity and quality of life in rheumatic diseases
ABSTRACT
Objectives: To evaluate the concentration of 1,25(OH)2D and 25(OH)D in patients with newly diagnosed juvenile idiopathic arthritis (JIA) determined before starting therapy and attempt to demonstrate the relationship between serum vitamin D metabolites and the activity and subtype of the disease.
Material and methods: A total of 50 children aged 2–16 years, who were diagnosed with JIA, were enrolled in the study. The control group comprised 28 children with matching age and gender, hospitalized due to circulatory system functional disorder. The level of the active metabolite of vitamin D in the sera was determined using the radioimmunoassay method and the 25(OH)D was tested using an ELISA immunoassay.
Results: The concentration of 1,25(OH)2D in the serum of children with the disease was statistically significantly lower compared to the children in the control group (34.86 ±17.14 pg/ml vs. 48.47 ±17.99 pg/ml, p = 0.0015 on average, respectively). However, the concentrations of 25(OH)D in both groups were comparable (17.36 ±8.44 ng/ml vs. 17.36 ±16.29 ng/ml on average), but lower than the recommended rate (i.e. < 30 ng/ml ). Higher mean concentrations of the active form of vitamin D in the serum of children with low activity of the disease compared to medium and high activity, but without statistical significance, was found. However, mean concentrations of 25(OH)D were the highest in the group with high disease activity but without statistical significance. Higher mean concentrations of the active form of vitamin D and 25(OH)D in the serum of children with oligoarthritis disease were demonstrated but without statistical significance.
Conclusions: Our results confirm the data on commonly occurring vitamin D deficiency in the developmental age population, which indicates the need for proper supplementation. Our finding – insufficiency of 25(OH)D as well as lower level of 1,25(OH)2 D compared to healthy children – can be the prerequisite for routine evaluation of metabolites of vitamin D in patients with JIA. There were no correlations between activity, type of JIA and metabolites of vitamin D.
Material and methods: A total of 50 children aged 2–16 years, who were diagnosed with JIA, were enrolled in the study. The control group comprised 28 children with matching age and gender, hospitalized due to circulatory system functional disorder. The level of the active metabolite of vitamin D in the sera was determined using the radioimmunoassay method and the 25(OH)D was tested using an ELISA immunoassay.
Results: The concentration of 1,25(OH)2D in the serum of children with the disease was statistically significantly lower compared to the children in the control group (34.86 ±17.14 pg/ml vs. 48.47 ±17.99 pg/ml, p = 0.0015 on average, respectively). However, the concentrations of 25(OH)D in both groups were comparable (17.36 ±8.44 ng/ml vs. 17.36 ±16.29 ng/ml on average), but lower than the recommended rate (i.e. < 30 ng/ml ). Higher mean concentrations of the active form of vitamin D in the serum of children with low activity of the disease compared to medium and high activity, but without statistical significance, was found. However, mean concentrations of 25(OH)D were the highest in the group with high disease activity but without statistical significance. Higher mean concentrations of the active form of vitamin D and 25(OH)D in the serum of children with oligoarthritis disease were demonstrated but without statistical significance.
Conclusions: Our results confirm the data on commonly occurring vitamin D deficiency in the developmental age population, which indicates the need for proper supplementation. Our finding – insufficiency of 25(OH)D as well as lower level of 1,25(OH)2 D compared to healthy children – can be the prerequisite for routine evaluation of metabolites of vitamin D in patients with JIA. There were no correlations between activity, type of JIA and metabolites of vitamin D.
REFERENCES (23)
1.
Baeke F, Takiishi T, Korf H, et al. Vitamin D: modulator of the immune system. Curr Opin Pharmacol 2010; 10: 482-496.
2.
Cantorna MT, Yu S, Bruce D. The paradoxical effects of vitamin D on Type 1 mediated immunity. Mol Aspects Med 2008; 29: 369-375.
3.
Cutillas-Marco E, Morales-Suárez-Varela MM, et al. Serum 25-hydroxyvitamin D levels in patients with cutaneous lupus erythematosus in a Mediterranean region. Lupus 2010; 19: 810-814.
4.
Pelajo CF, Lopez-Benitez JM, Miller LC. Vitamin D and autoimmune rheumatologic disorders. Autoimmun Rev 2010; 9: 507-510. .
5.
Jeffery LE, Burke F, Mura M, et al. 1,25-Dihydroxyvitamin D3 and IL-2 combine to inhibit T cell production of inflammatory cytokines and promote development of regulatory T cells expressing CTLA-4 and FoxP3. J Immunol 2009; 183: 5458-5467.
6.
Petty RE, Southwood TR, Manners P, et al. International League of Associations for Rheumatology. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31: 390-392.
7.
Consolaro A, Ruperto N, Bazso A, et al. Paediatric Rheumatology International Trials Organisation. Development and validation of a composite disease activity score for juvenile idiopathic arthritis. Arthritis Rheum 2009; 61: 658-666.
8.
Cutolo M, Plebani M, Shoenfeld Y, et al. Vitamin D endocrine system and the immune response in rheumatic diseases. Vitam Horm 2011; 86: 327-351.
9.
Littorin B, Blom P, Schölin A, et al. Lower levels of plasma 25-hydroxyvitamin D among young adults at diagnosis of autoimmune type 1 diabetes compared with control subjects: results from the nationwide Diabetes Incidence Study in Sweden (DISS). Diabetologia 2006; 49: 2847-2852.
10.
Szodoray P, Nakken B, Gaal J, et al. The complex role of vitamin D in autoimmune diseases. Scand J Immunol 2008; 68: 261-269. .
11.
Ascherio A, Munger KL, Simon KC. Vitamin D and multiple sclerosis. Lancet Neurol 2010; 9: 599-612.
12.
Joseph AJ, George B, Pulimood AB, et al. 25 (OH) vitamin D level in Crohn's disease: association with sun exposure and disease activity. Indian J Med Res 2009; 130: 133-137.
13.
WangTJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008; 117: 503-511.
14.
Forman JP, Curhan GC, Taylor EN. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension among young women. Hypertension 2008; 52: 828-832.
15.
Lips P. Relative value of 25(OH)D and 1,25(OH)2D measurements. J Bone Miner Res 2007; 22: 1668-1671.
16.
Dobrzańska A i Zespół Ekspertów. Polskie zalecenia dotyczące profilaktyki niedoboru witaminy D. Med Prakt Pediatr 2010; 1: 40-45.
17.
Baykal T, Senel K, Alp F, et al. Is there an association between serum 25-hydroxyvitamin D concentrations and disease activity in rheumatoid arthritis? Bratisl Lek Listy 2012; 113: 610-611.
18.
Reed A, Haugen M, Pachman LM, et al. Abnormalities in serum osteocalcin values in children with chronic rheumatic diseases. J Pediatr 1990; 116: 574-580.
19.
Pelajo CF, Lopez-Benitez JM, Kent DM, et al. 25-hydroxyvitamin D levels and juvenile idiopathic arthritis: Is there an association with disease activity? Rheumatol Int 2012; 32: 3923-3929.
20.
Rossini M, Maddali Bongi S, La Montagna G, et al. Vitamin D deficiency in rheumatoid arthritis: prevalence, determinants and associations with disease acitivty and disability. Arthritis Res Ther 2010; 12: R216.
21.
Turhanog˘lu AD, Güler H, Yönden Z, et al. The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. Rheumatol Int 2011; 31: 911-914.
22.
Cutolo M, Otsa K, Laas K, et al. Circannual vitamin D serum levels and disease activity in rheumatoid arthritis: Northern versus Southern Europe. Clin Exp Rheumatol 2006; 24: 702-704.
23.
Baker JF, Baker DG, Toedter G, et al. Associations between vitamin D, disease activity, and clinical response to therapy in rheumatoid arthritis. Clin Exp Rheumatol 2012; 30: 658-664.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
