Vitamin D deficiency in chronic inflammatory rheumatic diseases: results of the cardiovascular in rheumatology [CARMA] study.
BACKGROUND
The aim was to study the association between 25-hydroxyvitamin D (25(OH)D) levels and the clinical characteristics of patients with chronic inflammatory rheumatic diseases (CIRD).


METHODS
We studied a cross-section from the baseline visit of the CARMA project (CARdiovascular in rheuMAtology), a 10-year prospective study evaluating the risk of cardiovascular events in rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients, and non-CIRD patients who attended rheumatology outpatient clinics from 67 hospitals in Spain. Non-CIRD group was frequency matched by age with the joint distribution of the three CIRD groups included in the study. 25(OH)D deficiency was defined if 25(OH)D vitamin levels were < 20 ng/ml.


RESULTS
2.234 patients (775 RA, 738 AS and 721 PsA) and 677 non-CIRD subjects were assessed. The median (p25-p75) 25(OH)D levels were: 20.4 (14.4-29.2) ng/ml in RA, 20.9 (13.1-29.0) in AS, 20.0 (14.0-28.8) in PsA, and 24.8 (18.4-32.6) ng/ml in non-CIRD patients. We detected 25(OH)D deficiency in 40.5 % RA, 39.7 % AS, 40.9 % PsA and 26.7 % non-CIRD controls (p < 0.001). A statistically significant positive association between RA and 25(OH)D deficiency was found (adjusted (adj.) OR = 1.46; 95 % CI = 1.09-1.96); p = 0.012. This positive association did not reach statistical significance for AS (adj. OR 1.23; 95 % CI = 0.85-1.80) and PsA (adj. OR 1.32; 95 % CI = 0.94-1.84). When the parameters of disease activity, severity or functional impairment were assessed, a marginally significant association between 25(OH)D deficiency and ACPA positivity in RA patients (adj. OR = 1.45; 95 % CI = 0.99-2.12; p = 0.056), and between 25(OH)D deficiency and BASFI in AS patients (adj. OR = 1.08; 95 % CI = 0.99-1.17); p = 0.07) was also found.


CONCLUSIONS
Patients with RA show an increased risk of having 25(OH)D deficiency compared to non-CIRD controls.
Division of Rheumatology, Hospital Can Misses, Calle Corona s/n, 07800, Ibiza, Spain. anboliv@yahoo.es.
Ana
A
Urruticoechea-Arana
Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain. mauxiliadora.martin@ser.es.
María A
MA
Martín-Martínez
Division of Rheumatology, Hospital U de la Princesa, IIS-IPrincesa, Calle Diego de León 62, 28006, Madrid, Spain. scastas@gmail.com.
Santos
S
Castañeda
Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain. carlos.sanchez@ser.es.
Carlos A Sanchez
CA
Piedra
Division of Cardiology, Hospital Lucus Augusti, Lugo, 28001, Spain. carlos.gonzalez.juanatey@sergas.es.
Carlos
C
González-Juanatey
Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain. llorcaj@unican.es.
Javier
J
Llorca
Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain. federico.diaz.gonzalez@gmail.com.|Research Unit of Spanish Society of Rheumatology, Madrid, Spain. federico.diaz.gonzalez@gmail.com.|School of Medicine, Universidad de La Laguna, Tenerife, Spain. federico.diaz.gonzalez@gmail.com.
Federico
F
Díaz-Gonzalez
Division of Rheumatology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain. miguelaggay@hotmail.com.|Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida de Valdecilla, s/n, 39008, Santander, Spain. miguelaggay@hotmail.com.
Miguel A
MA
González-Gay
D000328:Adult; D000368:Aged; D015535:Arthritis, Psoriatic / Q000150:complications* / Q000378:metabolism; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000150:complications* / Q000378:metabolism; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012219:Rheumatology / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors; D013030:Spain; D013167:Spondylitis, Ankylosing / Q000150:complications* / Q000378:metabolism; D014807:Vitamin D / Q000031:analogs & derivatives / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications*
D014807:Vitamin D; C104450:25-hydroxyvitamin D