Over a decade ago, I had the pleasure of hearing Michael F. Holick, MD, PhD, discuss his cutting edge research on vitamin D. At the time, Dr. Holick was a largely unknown researcher focused on very much a niche area. Since that time, however, he has become a much more visible and highly accomplished researcher regarding the vitamin D deficiency pandemic and its role not only in causing metabolic bone disease and osteoporosis in adults, but also in increasing the risk among children and adults for the development of several common cancers, autoimmune diseases, type 1 diabetes, multiple sclerosis, and heart disease. In 2010, at the annual Rheumatology Nurses Society’s conference, we had the distinct honor of having him address our attendees. He was enthusiastically received.
Dr. Holick’s path has not been easy. As a trailblazer in the research of vitamin D, he was often scoffed at, accused of wasting time and energy on a topic that would “never amount to anything.” Due to his fervent belief and passion, though, I quickly became a fan of his and have followed the research on vitamin D since our first encounter many years ago. Based largely on his efforts, I have been thrilled to see the growing body of research on vitamin D and rheumatic disease both at national meetings and within the medical literature.
Several studies at the recent European League Against Rheumatism (EULAR) annual congress focused on vitamin D. One study of 136 patients with either rheumatic or irritable bowel diseases found that 61.8% of patients with rheumatic disease (RA, psoriatic arthritis, ankylosing spondylitis, and polymyalgia rheumatica) had vitamin D deficiency/insufficiency. This compared to 75.6% of patients with irritable bowel disease. The prevalence of vitamin D deficiency was higher in patients treated with biologic therapies compared to those treated with nonbiologic disease modifying antirheumatic drugs.1 Other studies presented at EULAR linked fatigue and symptom severity with low levels of vitamin D.2,3 These studies provide a small sample of research in recent years linking the severity of rheumatic diseases to vitamin D levels.
According to Dr. Holick, the goal in patients is to get levels of form 25-hydroxyvitamin D [25(OH)D] above 30 ng/ml.4 It is important to remember that, as a rule, 100 IU of Vitamin D3 raises levels of 25(OH)D by only 1 ng/ml. As we know from the research of Dr. Holick and others, vitamin D has a causative role not only in metabolic bone disease and osteoporosis in adults, but also in increasing the risk of children and adults developing common deadly cancers, autoimmune diseases, including the arthritides, type 1 diabetes, multiple sclerosis, and heart disease. Vitamin D deficiency has also been linked to diffuse musculoskeletal pain and severity of disease in RA.5
Diligence is required when ordering levels of 25(OH)D, prescribing supplementation, and following up to determine if a therapeutic level has been achieved. In my experience, raising vitamin D levels can be a long process. One patient of mine required 8 weeks of 50,000 IU/week supplementation just to reach an acceptable level.
Vitamin D might not be a lab test as unique to patients with RA as rheumatoid factor or anti-CCP, but it is important for us to remember that vitamin D has immunomodulatory properties such as decreasing antigen presentation and inhibiting proinflammatory T-helper cells.4,5 Thus, vitamin D supplementation may be beneficial for some of our rheumatic disease population
AUTHOR PROFILE: Sheree C. Carter, PhD, RN, is an Assistant Professor at The University of Alabama Capstone College of Nursing, Tuscaloosa, Alabama, and Former President of the Rheumatology Nurses Society.
- Bruzzese V, Ridola L, Zullo A, et al. High prevalence of vitamin D deficiency and insufficiency in patients with either rheumatic or inflammatory bowel diseases. Presented at the European League Against Rheumatism Annual Congress; June 10-13, 2015; Rome. Abstract AB0400.
- Choi BY, Chang SH, Song YW, et al. Vitamin D status and the efficacy of high-dose intramuscular cholecalciferol on musculoskeletal pain and morning fatigue in patients with chronic rheumatic diseases. Presented at: European League Against Rheumatism Annual Congress; June 10-13, 2015; Rome. Abstract THU307.
- Solmaz D, Avci O, Yalcin BC, et al. Vitamin D deficiency might contribute fatigue and disease activity in patients with fibromyalgia. Presented at: European League Against Rheumatism Annual Congress. June 10-13, 2015; Rome. Abstract #AB0944.
- Holick MF. Vitamin D status: measurement, interpretation and clinical application. Ann Epidemiol. 2009;19(2): 73–78. 5. Kostoglou-Athanassiou I, Athanassiou P, Lyraki A, Raftakis I, Antoniadis C. Vitamin D and rheumatoid arthritis. Ther Adv Endocrinol Metab. 2012;3(6): 181-187.