FRI0038 Vitamin D Serum Level in Early Arthritis Patients: Association with Disease Activity, Disability and Severity in the Espoir Cohort
Authors: E. Gamon, G. Mouterde, C. Lukas, M. Orsini, R. Seror, B. Combe
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Environmental factors may play a crucial role in auto-immune diseases. Besides tobacco, other factors like vitamin D are suspected to impact the onset and the subsequent activity of inflammatory arthritis including rheumatoid arthritis (RA), but its association with severity of the disease has not been evaluated yet. <h3>Objectives</h3> To examine the association of baseline vitamin D serum level with RA severity, disability, disease activity, response to treatment over the first year in early arthritis patients. <h3>Methods</h3> Patients presenting with synovitis of at least 2 joints for 6 weeks to 6 months were included in the multicenter French ESPOIR cohort. 25OH vitamin D2 and D3 was measured at baseline and then separated into 3 groups: deficiency (&lt;10 ng/ml), insufficiency (10-30 ngl/mL), normal level (≥30ng/mL). Correlation between vitamin D levels and DAS28, HAQ and van der Heijde modified total Sharp score (mTSS) were assessed at baseline by a Spearman correlation analysis. Bivariate analyses of the association between baseline vitamin D level and other outcomes were conducted: radiographic progression defined by an increase of at least 1 point of the mTSS at 12 months; disability (defined by an HAQ≥1); disease activity (DAS28) and RA diagnosis (2010 ACR/EULAR criteria) at baseline, 6 and 12 months; response to treatment (EULAR response) at 6 and 12 months. Forward stepwise multiple logistic regression was used to evaluate independent association between baseline variables and formerly described outcomes. <h3>Results</h3> Among 813 patients included in the cohort, 810 were analyzed and 138 (16.97%), 522 (64.21%), 150 (18.45%) had vit D&lt;10, 10-30 and ≥30ng/mL respectively. Vitamin D levels were found to be correlated with DAS28, mTSS and HAQ at baseline (Rho=-0.11, p=0.0016; Rho=-0.07, p=0.0335 and Rho=-0.11, p=0.0016 respectively). In bivariate analyses, patients with vitamin D deficiency had more radiographic progression at 12 months compared to vitamin D normal group (OR=1.82 95% CI 1.05-3.15, p=0.0323). Patients with a HAQ ≥1 were more frequent in deficiency group compared to normal group at baseline and 6 months (OR=1.89 95% CI 1.18-3.03, p=0.008 and OR=2 95% CI 1.15-3.49 p=0.0146 respectively). Patients with DAS28&gt;5.1 were more frequent in deficiency group compared to normal group at baseline (OR=1.84 95%CI 1.15-2.87 p=0.011). There was no link between vitamin D level and RA diagnosis at baseline, 6 and 12 months nor with response to treatment at 6 and 12 months. In multivariate analysis, radiographic progression at 12 months was associated with vitamin D deficiency (OR=1.95 95% CI 1.05-3.62, p=0.038), age, ACPA, CRP, alcohol consumption and season of onset. Likewise, disability at baseline was associated with vitamin D deficiency (OR=1.73 95% CI 1.05-2.85, p=0.03), age, CRP, corticosteroid use and disease duration; disability at 6 months was associated with vitamin D deficiency (OR=2.01 95% CI 1.15-3.52, p=0.025), age and sex. <h3>Conclusions</h3> Vitamin D deficiency may be predictive of radiographic progression at 1 year and is associated with increased disability at baseline and 6 months in early arthritis patients. These data reinforce the role of environmental factors in the development and outcome of RA. <h3>Disclosure of Interest</h3> None declared