Vitamin D deficiency can cause rheumatism?

*Only for medical professionals to read and refer to the latest hot spots of the conference, the exciting first look! On May 20, 2021, the twenty-fifth academic conference of the Chinese Association of Rheumatology (CRA) was successfully held.
The following will take you to the forefront of the CRA conference and listen to the latest academic research progress.

Rheumatoid arthritis (RA) is a systemic disease with chronic inflammation of synovial joints as the main clinical manifestations.
Among them, T cells and certain cytokines play an important role in the pathogenesis of RA.

In recent years, studies have found that vitamin D not only participates in calcium and phosphorus metabolism, improves local and even systemic osteoporosis of RA, but also has obvious immunomodulatory effects.

At this annual meeting, Professor Zhao Dongbao, director of the Department of Rheumatology and Immunology, Changhai Hospital Affiliated to Naval Military Medical University, gave a detailed account of the "new development of vitamin D research".

Later, Professor Zhao Dongbao was a guest at the live broadcast room of "Famous Doctor Kung Fu Tea, Approaching CRA" to share with us the essence of this CRA and express professional opinions.

Picture: On the right is Professor Zhao Dongbao's guest in the live broadcast room, and on the left is Dr.
Ling Guanghui's guest host.
Vitamin D also has an effect on tissue cells throughout the body! Professor Zhao Dongbao introduced that vitamin D is a group of fat-soluble ring-opening sterol-like substances, also known as D hormones, not vitamins.

Vitamin D2, also known as ergosterol, is derived from plant foods (mushrooms).

Vitamin D3, also known as cholecalciferol, is produced by the skin after being irradiated with sunlight or artificial ultraviolet B rays.
It is derived from animal food (deep sea fish, egg yolk, liver).

The skeletal effects of vitamin D mainly include: (1) Promote calcium absorption: promote the absorption of calcium and phosphorus by the brush border of the small intestinal mucosa; (2) prevent calcium loss: promote the reabsorption of calcium and phosphorus by the renal tubules, maintain and regulate plasma Normal concentration of calcium and phosphorus; (3) Promote calcium deposition: promote calcium deposition in the new bone formation site, so that citrate is deposited in the bone; (4) promote bone remodeling: promote bone calcification and bone cell function and bone-like tissue mature.

Professor Zhao Dongbao said that vitamin D not only has an effect on calcium and phosphorus metabolism and bone calcification, but also has a wide range of effects on tissue cells throughout the body.

Vitamin D deficiency causes rheumatism? Vitamin D deficiency can bring many harms to the human body, including typical intraosseous effects (rickets, rickets, osteoporosis) and atypical extraosseous effects (cardiovascular disease, diabetes, tumor, hypertension, chronic kidney disease, self) Immune disease).

Therefore, the treatment of vitamin D deficiency can significantly increase the response rate and effective rate of disease treatment, improve the prognosis of the disease, and open up a new field for the clinical application of vitamin D.

Vitamin D can regulate the immune response of the human body At the conference, Professor Zhao Dongbao described in detail the effect of vitamin D on immune cells and inflammatory factors.

The body's immune cells (including T cells, NK cells, B lymphocytes, etc.
) are inseparable from vitamin D, so vitamin D can regulate the body's immune response, and its immune response mainly includes suppression and promotion.

Inhibition is aimed at some disease-causing cells or cytokines of the human body, such as interleukin-1 (IL-1), IL-6, tumor necrosis factor-α (TNF-α), etc.
, while anti-inflammatory cytokines, such as IL -10 and so on, it will promote the effect.

Figure 1: The effect of vitamin D on immune cells Figure 2: The effect of vitamin D on inflammatory factors Professor Zhao Dongbao emphasized that for high-risk groups who would benefit from vitamin D testing, experts have reached a consensus that vitamin D testing should be The baseline and 3-month intervals are performed until the desired concentration is obtained.

The recommended population for vitamin D testing includes: (1) patients with bone loss or high risk; (2) patients with insufficient endogenous vitamin D production; (3) patients with abnormal vitamin D metabolism.

Professor Zhao Dongbao said that the detection of serum 25-(OH)D is the "gold standard" for the diagnosis of vitamin D deficiency.

Figure 3: The significance of serum 25-(OH)D detection What is the relationship between vitamin D and RA? Professor Zhao Dongbao shared a 2016 related study at the meeting.

Studies have shown that Meta analysis suggests that the vitamin D level of RA patients is significantly lower than that of healthy people, and the vitamin D level of RA patients is negatively correlated with disease activity DAS28.

At the same time, Professor Zhao Dongbao also introduced a 2015 randomized controlled trial (RCT) study.
According to the baseline vitamin D level of RA patients, the study was divided into a normal group and a deficiency group, and the deficiency group was randomly divided into vitamin D treatment subgroups and vitamin D treatment subgroups.
In the subgroup without vitamin D treatment, the recurrence rates of the three groups were 16.
7%, 19%, and 29.
5%, respectively.
This suggests that vitamin D supplementation can not only improve BMD, but also reduce the recurrence of RA.

Figure 4: Screenshot of the RCT study data can vitamin D reduce SLE disease activity? In addition, Professor Zhao Dongbao said that some studies suggest that vitamin D deficiency is associated with mild to moderate activity in systemic lupus erythematosus (SLE), but does not affect important organs.

But another part of the research suggests that vitamin D deficiency has nothing to do with SLE disease activity.

In 2016, an RCT study compared the addition of vitamin D to 50000 IU/week in SLE patients with childhood onset.
After 24 weeks, it was found that vitamin D can reduce disease activity and relieve fatigue-related scores, but other RCT studies did not This conclusion was not reached, so this result is still controversial.

Figure 5: Disease activity scores of SLE patients after 6 months of VD treatment.
Current studies have also shown that vitamin D treatment of SLE can reduce the amount of hormones.

A study of 104 patients with SLE showed that patients were able to reduce the use of glucocorticoids at the 12th and 24th weeks after VD2 treatment.

Figure 6: Vitamin D treatment of SLE can reduce the amount of hormones.
Low vitamin D levels, strong activity in psoriatic arthritis? In addition, the level of 25-(OH)D is negatively correlated with the degree of skin involvement.

Among subjects with insufficient vitamin D levels, patients with psoriatic arthritis have greater disease activity, and vitamin D deficiency promotes the development of skin damage and joint symptoms.

How to supplement vitamin D? The American Academy of Rheumatology "Recommendations for the Prevention and Treatment of Glucocorticoid Osteoporosis" (2017 edition) stated that for all patients who start taking glucocorticoids (GCs), it is recommended to supplement calcium and vitamin D, and treat vitamin D.
Deficiency.

Because GCs interfere with the absorption of vitamin D, a higher supplement dose is required.

According to the recommendations of the "2020 China Expert Consensus on Glucocorticoid-induced Osteoporosis Prevention and Treatment" issued by the Chinese Society of Rheumatology, all adult patients who are expected to require hormone therapy for ≥3 months (any dosage and route of administration) need to be supplemented daily Elemental calcium, vitamin D or active vitamin D.

Similarly, the "Guidelines for Diagnosis and Treatment of Dermal Lupus Erythematosus" (2019 edition) of the Chinese Medical Association Dermatology Branch also reminded patients that they should avoid adverse irritation, including sun protection, cold protection, smoking cessation, avoiding trauma, etc.
, pay attention to vitamin D supplementation, and try to avoid high salt Diet and photosensitivity food, etc.

Professor Zhao Dongbao said that vitamin D deficiency is almost related to most important diseases to varying degrees.

In recent years, studies at home and abroad have found that the treatment of vitamin D deficiency with the dose for the treatment of bone diseases is difficult to meet the treatment needs of extraosseous diseases.

It is worth noting that many chronic diseases, severe diseases, and combined drugs will significantly reduce the 25-(OH)D level of simultaneous treatment, so the treatment of many diseases also requires 25-(OH)D values ​​to reach a higher level.
There is a better treatment effect.

Professor Zhao Dongbao suggested that the requirement for vitamin D should be differentiated between nutritional requirement and treatment requirement.

The currently proposed dose is only satisfied with nutrition, and the nutritional dose is small, the effect is not immediate, and it is affected by many complex factors.

In this regard, the American Medical Association recommends that the amount of vitamin D supplementation must be increased again.

Finally, Professor Zhao Dongbao concluded that vitamin D deficiency or deficiency is related to most autoimmune diseases, including RA, SLE, ankylosing spondylitis, and psoriatic arthritis.

Ordinary vitamin D is the only medicine in China that can raise the level of 25-(OH)D, and intramuscular injection is better than oral.

Intramuscular injection of vitamin D2 injection can quickly and steadily increase the level of 25-(OH)D, and can improve the therapeutic effect of a variety of autoimmune diseases, reduce body allergies and inflammatory reactions, improve bone and joint pain, and regulate bone metabolism.