FRI0078 European Pilot Study on Vitamin D Serum Levels and Disease Activity in Rheumatoid Arthritis Patients
Authors: M. Cutolo, A. Tincani, J. Vojinovic, L. Andreoli, F. Dall'Ara, R. Ionescu, K. Simic-Pasalic, M. Sefik-Bukilica, I. Astica, I. Ferraz, M. Tlustochowicz, J. Morovic-Vergles, I. Butrimienė, E. Punceviciene, N. Toroptsova, S. Grazio, M. Pavol, J. Rovensky, S. Soldano, F. Salaffi, A. Sulli
Journal: Annals of the Rheumatic Diseases (2014)

<h3>Background</h3> Several studies have demonstrated low 25(OH)D3 serum levels, which could influence pathogenesis and clinical outcomes of immune-mediated diseases such as rheumatoid arthritis (RA) (1,2). <h3>Objectives</h3> In order to investigate the necessity to implement specific vitamin D patient related outcomes we performed a pilot European multicentre study, involving individuals from different countries/latitudes, to explore 25(OH)D<sub>3</sub> serum levels and their possible correlation with disease activity and related outcomes in RA patients during winter season. <h3>Methods</h3> We enrolled 270 RA patients (not treated with vitamin D supplementation) and 180 healthy subjects as controls (CNT), from Rheumatology centers in 10 European countries. RA patients mean disease duration was 10±9 years and mean age 56±10 years. Patients informed consent was obtained before collecting blood samples. Complete medical history, health assessment questionnaire (HAQ), rheumatoid arthritis impact disease score (RAID), disease activity scale (DAS28) were recorded. 25(OH)D<sub>3</sub> serum levels were evaluated centrally using chemiluminescence immunoassay with an automatic analyser (LIAISON, DiaSorin), and classified as normal (&gt;30 ng/ml), insufficient (between 20 and 30 ng/ml) or deficient (&lt;20 ng/ml) (3). <h3>Results</h3> 25(OH)D<sub>3</sub> serum levels were significantly lower in RA patients compared to controls (median 16 vs 20 ng/ml) (p&lt;0.0001). In particular, we registered 25(OH)D<sub>3</sub> deficiency (&lt;20 ng/ml) in 25% and insufficiency in 70% of RA patients. Male and female RA patients showed similar 25(OH)D<sub>3</sub> values (median 19 vs 17 ng/ml) (p=n.s.). We found statistically significant difference in 25(OH)D<sub>3</sub> levels between some European countries such as significantly higher 25(OH)D<sub>3</sub> serum levels in Spanish RA patients (Canaries Islands) compared to patients from Latvia, Lithuania, Romania, Croatia, Russia and Italy (p&lt;0.01). In agreement with previous observations (4), we found in RA patients statistically significant negative correlations between 25(OH)D<sub>3</sub> values and HAQ (r=-0.29, p=0.03), RAID (r=-0.32, p=0.02), and DAS28 scores (r=-0.41, p=0.003), respectively. <h3>Conclusions</h3> The results of this multicentre study confirms, at least in winter time, the presence of significantly lower 25(OH)D<sub>3</sub> serum levels in RA patients than in healthy control subjects, which seem correlated with disease activity at all latitudes in Europe. The significant negative correlations observed between 25(OH)D<sub>3</sub> serum levels and DAS28, HAQ and RAID scores justify the need to develop specific questionnaires for patient reported outcomes (PRO) vitamin D-related, and to validate them in a large European multicentre study. <h3>References</h3> 1. Cutolo et al. Autoimmun Rev 2011;11:84-87. Aranow C. J Investig Med. 2011; 59: 881–886. 3. Holick MF. N Engl J Med 2007;357:266-81. 4. Cutolo M. Ann Rheum Dis 2013;72:473-5. <h3>Disclosure of Interest</h3> None declared <h3>DOI</h3> 10.1136/annrheumdis-2014-eular.4145