C. Kelly, K. Scott, G. Bell, E. Pellas, C. Tully, J. Dyson. Rheumatology, Queen Elizabeth Hospital, Gateshead, United Kingdom

Background: Interest in the role of vitamin D in rheumatic disease has developed apace with reports that low levels of vitamin D may be associated with inflammatory joint disease and other auto immune disorders. Indeed, low levels of vitamin D have been reported in a wide variety of different rheumatic disease processes. The relevance of these findings in some categories of musculoskeletal disease remains unclear.
Objectives: We performed a comparative study of vitamin D levels in outpatients with a wide range of rheumatic disease to assess mean levels of vitamin D in inflammatory joint disease, osteoporosis and myalgia.
Methods: We measured 25-hydroxy D levels in four groups of outpatients recruited from clinic. The groups comprised 30 patients with each of: Rheumatoid arthritis (RA), osteoporosis, unexplained muscle pain, and a control group with chronic low back pain of over 6 months duration (n= 90). Patients already on supplements with vitamin D and calcium were excluded from this study. Our normal range for vitamin D is 48-145 nmol/l. and we calculated median levels (range) in each group. We compared values within the three groups with values of those control patients with chronic pain using Students unpaired t test.
Results: Groups were matched for age and gender mix with a female: male ratio of 2:1 and a mean age of 58 years. Within all patients combined (n=180), the overall median level of vitamin D was 38 nmol/l and 58% of individuals had values below the normal range. Median values in the control group were 51 nmol/l (range 11–105 nmol/l). All three comparator patient groups had significantly reduced levels. RA patients had median levels of vitamin D of 36 nmol/l (range 16-85 nmol/l) [p=0.045]. Levels in osteoporosis patients were even lower with a median value of 31 nmol/l (range 7-82 nmol/l) [p=0.005]. Intriguingly, patients with unexplained muscle pain had equally low median levels of vitamin D at 31 nmol/l (range 11-79 nmol/l) [p= 0.008].
Conclusion: Our data confirms that vitamin D deficiency is common in patients with a range of rheumatic diseases. It supports published evidence showing that vitamin D levels are low in RA and supports the need to consider supplementation in such patients. The relevance of vitamin D deficiency in osteoporosis is well recognised and our data supports the need for routine supplementation in such patients. Less anticipated was our finding of low levels of vitamin D among patients with diffuse muscle pain. This may represent a symptomatic manifestation of vitamin D deficiency in a significant proportion of such patients and highlights the need to consider this within the differential diagnosis of muscle pain.
Disclosure of Interest: None declared

Citation: Ann Rheum Dis 2010;69(Suppl3):481

Session: Epidemiology, health services and outcome research


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