AB0986 VITAMIN D LEVEL AND BONE MINERAL DENSITY IN PATIENTS WITH JUVENILE RHEUMATOID ARTHRITIS
Authors: Tetiana Marushko, Yuliia Holubovska, Yurii Marushko
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> An impaired bone metabolism is observed in patients with juvenile idiopathic arthritis (JIA), associated both with the activation of pro-inflammatory cytokines and use of steroid medications. The majority of children with JIA have low vitamin D level, which may complicate the disease course. We regard the monitoring of bone mineral density (BMD) in patients with juvenile rheumatoid arthritis (JRA) should be complemented with an additional assessment of calcidiol (25(OH)D) serum level as an indicator of BMD and a criterion of successful therapy. <h3>Objectives</h3> To evaluate the bone densitometry data and calcidiol level in patients with JRA in order to estimate the osteopenic syndrome and the advisability of prescribing the vitamin D additional doses. <h3>Methods</h3> The calcidiol level and BMD data in 65 patients with JIA were assessed (41 girls and 24 boys). All children were divided into 2 groups, depending on the therapy type. Group I consisted of patients who received methotrexate (n = 37), Group II – patients who received the biological DMARDs (n = 28), namely tocilizumab (6 patients), adalimumab (20 patients) and etanercept (2 patients). At the time of the study, 14 children of the Group II were prescribed the biological DMARDs only, while the 12 patients were in the state of clinical remission unlike the 7 patients of Group І. It should be mentioned that the majority of children in the Group II had high disease activity degrees before the start of treatment with biological DMARDs. In order to show the correlation between BMD and disease activity, cJADAS-27 score result for the last 6 months was estimated. The data were processed using Pearson's chi-squared test and Spearman's Rank correlation coefficient. <h3>Results</h3> The study revealed, 60 children (92% of all patients) showed vitamin D insufficiency, that mainly manifested by decreased calcidiol level (from 21 to 29 ng/ml), only 8 children (12%) showed calcidiol level deficiency (&lt;20 ng/ml). A significant difference was found in the BMD results depending on the therapy type (χ2 = 10.05; p &lt;0.01) using Pearson's chi-squared test. As a result, children who received biological DMARDs, demonstrated significantly better results according to BMD assessment data. A direct association of moderate strength was found (the correlation coefficient (r-Spearman's) is 0,39). The strong negative association (r-Spearman's was -0,72) was observed between BMD assessment data and cJADAS-27 score result, which confirmed our statement – high disease activity affects the bone tissue mineralization. There was a weak negative association between 25(OH)D level and cJADAS-27 score result (r-Spearman's was -0,15). <h3>Conclusion</h3> There was a paucity of vitamin D level in 92% of patients with JRA, in 60% ̶ secondary osteopenic syndrome. It was revealed that patients, who receive biological DMARDs in integrated treatment, demonstrate significantly better results according to BMD assessment data. Calcidiol level has a moderate effect on BMD, while BMD strongly depends on disease activity degree according to the Spearman's Rank correlation coefficient. <h3>Disclosure of Interests</h3> None declared