AB0515 MICRONUTRIENT DEFICIENCIES IN PATIENTS WITH SPONDYLOARTHRITIS: AGE AND GENDER IMPLICATIONS
Authors: P. Triggianese, F. Caso, A. D’antonio, P. Conigliaro, S. Ferrigno, L. Costa, M. Tasso, M. S. Chimenti, R. Perricone
Journal: Annals of the Rheumatic Diseases (2021)

Background: Micronutrient deficiencies (MNDs) are common among patients with chronic inflammatory diseases. These are associated with a pro-inflammatory status and co-morbidities, and influenced by several factors, such as age and gender. Objectives: No any study has investigated MNDs and their correlation with gender in Spondyloarthritis (SpA). With this purpose, this study analyzed the occurrence of anemia and the status of ferritin (Fe), vitamin D [25(OH)D], vitamin B12 (B12), and folic acid (FA) in a cohort of patients with SpA. Methods: Levels of Hb, Fe, 25(OH)D, B12, FA, were evaluated in 220 SpA outpatients (137 females and 83 age-matched males) with Psoriatic arthritis (PsA, n=110) and SpA (n=110). Disease activity was assessed by DAPSA or ASDAS-CRP as appropriate and functional status was evaluated with HAQ score. Body Mass Index (BMI) was selected as a metabolic clinic parameter. Results: Male and female patients were similar for disease duration and severity as well as the distribution of diagnosis and treatments (Table 1). In males, BMI was higher than in females (P=0.03) and positively correlated with the age (P=0.01). In female patients, BMI directly correlated with HAQ (P=0.03). The prevalence of anemia (Hb&lt;12) was 13.6% of the study cohort; half of anemic patients had PsA, the others had enteropathic SpA (ESpA). Anemia resulted almost wholly in female patients (99%). In the male group, Hb resulted inversely related to age (P=0.01) and CRP levels (P=0.008). Ferritin was lower in females than in males (P=0.0003). 25(OH)D deficiency (≤20 ng/ml) was present in 23.2% of the cohort: males had lower 25(OH)D than females (P=0.02). Among male patients, disease duration correlated positively with ferritin (P&lt;0.001) and inversely with 25(OH)D (P=0.02). Low levels of serum B12 (≤200 pmol/l) were rare (13.2%), while deficiency in FA (≤4 ng/ml) was frequent (22%) and associated with B12 defect in 31% of cases, with almost similar occurrence in males and females. A diagnosis of ESpA occurred in 55% of cases with B12 deficiency and 62.5% of FA defect, without gender difference. Mean levels of ferritin, 25(OH)D, B12, and FA did not differ significantly between PsA and SpA patients. Table 1. Data from the study population. Females (n=137 ) Males (n=83 ) P Age (yrs; § ) 51.65 ± 13 52.9 ± 12.8 NS BMI (* ) 24 [17.2 - 50.2] 25.8 [19.6 - 43.6] &lt; 0.05 CRP (mg/l; * ) 2.9 [0 - 53] 2 [0 - 61] NS Hb (g/dl; § ) 13 ± 1.2 14.4 ± 1.4 NS Fe (mg/l; * ) 37 [2 - 148] 64 [4 - 452] &lt; 0.05 25(OH)D (ng/ml; * ) 28.2 [5 - 67] 25 [5 - 50] &lt; 0.05 Vitamin B12 (pmol/l; * ) 350 [60 - 990] 313 [47 - 797] NS Folic Acid (ng/ml; * ) 7 [1.7 - 40] 6.9 [1.8 - 39] NS PsA (N/% ) 73/68.23 34/31.77 NS SpA (N/% ) 64/41 49/59 NS Concomitant IBD (n/% ) 56/65.9 29/34.1 NS Disease duration (months; * ) 69 [6 - 540] 76.5 [3 - 768] NS Low D.A. (N/% ) 62/45.25 47/56.6 NS Moderate-high D.A. (N/% ) 75/54.75 36/43.4 NS COXIB-inhibitors (N/% ) 21/15.4 8/9.6 NS cDMARDs monotherapy (N/% ) 35/25.5 10/12 NS bDMARDs (N/% ) 81/59.12 65/78.4 NS BMI, body mass index; CRP, C-reactive protein; Hb, haemoglobin; Fe, ferritin; 25(OH)D, vitamin D; PsA, psoriatic arthritis; SpA, spondyloarthritis; IBD, inflammatory bowel disease; D.A., disease activity; cDMARDs, conventional Disease Modifying Antirheumatic Drugs; bDMARDs, biological DMARDs; § mean ± SD; * median [min-max]. Conclusion: Our study describes for the first time the possibility of a relevant prevalence of MNDs in SpA patients. Furthermore, we show that MNDs could be also influenced by gender difference and age. Of note, our findings highlight the importance of a screening focused on MNDs in SpA patients. This could be key in optimizing management of SpA patients, in which inflammatory-dependent dysmetabolism is frequent. References: [1]Yamamoto EA, Jørgensen TN. Relationships Between Vitamin D, Gut Microbiome, and Systemic Autoimmunity. Front Immunol. 2020;10:3141. [2]Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12:2097. [3]Bañuls-Mirete M, Ogdie A, Guma M. Micronutrients: Essential Treatment for Inflammatory Arthritis? Curr Rheumatol Rep. 2020;22:87. Disclosure of Interests: None declared.