vitamin D and MSA recent study published in the journal Rheumatology found that vitamin D levels are significantly associated with disease activity, levels of inflammatory cytokines, and bone loss in patients with rheumatoid arthritis.

Several studies have shown that patients with RA have lower vitamin D levels. Research has demonstrated that vitamin D works with the immune system by regulating immune cells that produce inflammatory or anti-inflammatory proteins called cytokines.

Interleukin-17 (IL-17) and interleukin-23 (IL-23) are two pro-inflammatory cytokines that are involved in the inflammatory response in autoimmune diseases. Studies have demonstrated that increased levels of these cytokines are associated with increased RA disease activity, but there is no evidence to prove vitamin D status is associated with these cytokines in patients with RA.

Researchers conducted a study to compare vitamin D status with levels of cytokines, disease severity, and degree of bone loss (osteopenia) in patients with RA. The goal to determine if vitamin D levels were associated with any of these factors related to RA.

The study consisted of 130 patients with RA, who were matched by 80 healthy individuals the local community.

All of the RA patients were classified into 3 groups according to their Disease Activity Score in 28 joints (DAS28): low (DAS28 < 3.2), moderate (DAS28 < 3.2-5.1) and severe (DAS28 > 5.1). DAS28 is a quantitative measurement of disease activity used to monitor the treatment of rheumatoid arthritis.

In addition to DAS28, other quantitative measurements used to assess disease activity were taken, which included morning stiffness time, tender joint count (TJC), swollen joint count (SJC) and Health Assessment Questionnaire (HAQ) score. An increase in these measurements indicate increased disease severity.

Measurements of vitamin D levels, IL-17 and IL-23 levels, bone mineral density (BMD), and bone erosion were also taken.

The research team wanted to see how vitamin D status was related to IL-17 and IL-23, disease severity, and bone loss in RA patients.

Statistical analysis showed the following results:

RA patients had significantly lower vitamin D levels compared to controls.
Vitamin D levels were significantly negatively associated with DAS28, morning stiffness time, TJC, SJC, and HAQ score.
Vitamin D levels were significantly negatively associated with IL-17 and IL-23 levels.
In RA patients, individuals with osteoporosis and osteopenia had significantly lower vitamin D levels than patients with normal BMD.

The researchers concluded the lower levels of 25(OH)D were associated with increased disease activity, including SJC, TJC, joint pain degree, morning stiffness time and HAQ score. Serum levels of 25(OH)D were also negatively associated with DAS28 score, ESR, platelets, IL-17 and IL-23. In addition, patients with osteoporosis and osteopenia had significantly lower levels of 25(OH)D than those with normal bone mineral density.

This study shows an expanded picture of the link between vitamin D and inflammatory cytokines, disease activity, and bone mineral density in RA patients. Vitamin D levels are one variable in the an integrative approach to autoimmune disease. It is important to rule of out GI infections, gluten intolerance, food sensitivities, and “leaky gut”.


Hong, Q. et al. Associations between serum 25-hydroxyvitamin D and disease activity, inflammatory cytokines and bone loss in patients with rheumatoid arthritis. Rheumatology, 2014.

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