Vitamin D in rheumatoid arthritis-towards clinical application.
In addition to its well-documented involvement in mineral homeostasis, vitamin D seems to have broad effects on human health that go beyond the skeletal system. Prominent among these so-called nonclassical effects of vitamin D are its immunomodulatory properties. In vitro studies have shown anti-inflammatory effects of 1,25-dihydroxyvitamin D (1,25(OH)2D), the active form of vitamin D. In addition, epidemiological analysis of patients with established inflammatory disease identified associations between vitamin D deficiency (low serum concentrations of inactive 25-hydroxyvitamin D, abbreviated to 25(OH)D) and inflammatory conditions, including rheumatoid arthritis (RA). The association of vitamin D deficiency with RA severity supports the hypothesis of a role for vitamin D in the initiation or progression of the disease, or possibly both. However, whether 25(OH)D status is a cause or consequence of RA is still incompletely understood and requires further analysis in prospective vitamin D supplementation trials. The characterization of factors that promote the transition from preclinical to clinical phases of RA has become a major focus of research, with the aim to facilitate earlier diagnosis and treatment, and improve therapeutic outcomes. In this Review, we aim to describe the current knowledge of vitamin D and the immune system specifically in RA, and discuss the potential benefits that vitamin D might have on slowing RA progression.
Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham B15 2TH, UK.
Louisa E
LE
Jeffery
Institute of Inflammation and Ageing, College of Medical and Dental Sciences, The University of Birmingham, Birmingham B15 2TH, UK.
Karim
K
Raza
Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, The University of Birmingham, Birmingham B15 2TH, UK.
Martin
M
Hewison
D000893:Anti-Inflammatory Agents / Q000494:pharmacology; D000938:Antigen-Presenting Cells / Q000502:physiology; D001172:Arthritis, Rheumatoid / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D001402:B-Lymphocytes / Q000502:physiology; D016922:Cellular Senescence / Q000502:physiology; D018450:Disease Progression; D005347:Fibroblasts / Q000502:physiology; D006801:Humans; D007154:Immune System Diseases / Q000209:etiology; D007155:Immunologic Factors / Q000494:pharmacology*; D006377:T-Lymphocytes, Helper-Inducer / Q000502:physiology; D014807:Vitamin D / Q000378:metabolism / Q000494:pharmacology* / Q000502:physiology; D014808:Vitamin D Deficiency / Q000150:complications
D000893:Anti-Inflammatory Agents; D007155:Immunologic Factors; D014807:Vitamin D