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Vitamin D as an Adjuvant in Rheumatoid Arthritis: A Systematic Review of Existing Literature

Year 2025, Volume: 45 Issue: 3, 255 - 267, 01.09.2025
https://doi.org/10.52794/hujpharm.1573889

Abstract

Rheumatoid Arthritis (RA) is a progressive inflammatory complication that negatively affects quality of life by causing the immune system to attack and damage joint cartilage and bones. Several immune illnesses, including RA, have been linked to Vitamin D (Vit D) deficiency. Based on current evidence, this systematic review investigates the connection between RA and blood Vit D levels, as well as the impact of supplementation on disease activity. This systematic review examined research papers in scientific databases from 2018 to 2023. Fourteen publications were chosen for final reporting based on specific inclusion and exclusion criteria. Vit D supplements were linked to positive effects in people with RA, and there is a detrimental correlation between the amount of the Vit D and the development and pathogenesis of the illness. However, none of these publications made any conclusive claims of an extensive cure or remission from RA. Vit D has been found to be moderately correlated with the course and activity of RA, and taking supplements of this vitamin may be advantageous in managing the condition. More diverse cohort studies and randomized controlled trials are needed to corroborate these findings and develop full Vit D recommendations for RA treatment.

Ethical Statement

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Supporting Institution

NEMCARE Group of Institutions

References

  • 1. Khan MU, Gautam G, Jan B, Zahiruddin S, Parveen R, Ahmad S. Vitamin D from Vegetable VV Sources: Hope for the Future. Phytomedicine Plus. 2022;2(2):100248. doi:10.1016/j.phyplu.2022.100248
  • 2. Harrison SR, Li D, Jeffery LE, Raza K, Hewison M. Vitamin D, Autoimmune Disease and Rheumatoid Arthritis. Calcif Tissue Int. 2020;106(1):58-75. doi:10.1007/s00223-019-00577-2
  • 3. Matsui MS. Vitamin D Update. Curr Dermatol Rep. 2020;9(4):323-330. doi:10.1007/s13671-020-00315-0
  • 4. Mustafa A, Shekhar C. Concentration levels of serum 25-Hydroxyvitamin-D and vitamin D deficiency among children and adolescents of India: a descriptive cross-sectional study. BMC Pediatr. 2021;21(1):1-10. doi:10.1186/s12887-021-02803-z
  • 5. Kowalówka M, Główka AK, Karaźniewicz-łada M, Kosewski G. Clinical significance of analysis of vitamin d status in various diseases. Nutrients. 2020;12(9):1-31. doi:10.3390/nu12092788
  • 6. Holick MF. Vitamin D status: measurement, interpretation, and clinical application. Ann Epidemiol. 2009;19(2):73-78. doi:10.1016/j.annepidem.2007.12.001
  • 7. Pludowski P, Grant WB, Karras SN, Zittermann A, Pilz S. Vitamin D Supplementation: A Review of the Evidence Arguing for a Daily Dose of 2000 International Units (50 µg) of Vitamin D for Adults in the General Population. Nutrients. 2024;16(3). doi:10.3390/nu16030391
  • 8. Williams SE. Vitamin D supplementation: Pearls for practicing clinicians. Cleve Clin J Med. 2022;89(3):154 LP - 160. doi:10.3949/ccjm.89a.21021
  • 9. Holick aroenngam and MF. Immunologic Effects of Vitamin D on Human Health and Disease. Am Heart J. 2013;26(2):132-143.
  • 10. Dankers W, Colin EM, van Hamburg JP, Lubberts E. Vitamin D in autoimmunity: Molecular mechanisms and therapeutic potential. Front Immunol. 2017;7(JAN). doi:10.3389/fimmu.2016.00697
  • 11. Fletcher J, Bishop EL, Harrison SR, Swift A, Cooper SC, Dimeloe SK, et al. Autoimmune disease and interconnections with vitamin D. Endocr Connect. 2022;11(3). doi:10.1530/EC-21-0554
  • 12. Cao F, Hu LQ, Yao SR, Hu Y, Wang DG, Fan YG, et al. P2X7 receptor: A potential therapeutic target for autoimmune diseases. Autoimmun Rev. 2019;18(8):767-777. doi:10.1016/j.autrev.2019.06.009
  • 13. Shukla SK, Singh G, Ahmad S, Pant P. Infections, genetic and environmental factors in pathogenesis of autoimmune thyroid diseases. Microb Pathog. 2018;116:279-288. doi:10.1016/j.micpath.2018.01.004
  • 14. Fugger L, Jensen LT, Rossjohn J. Challenges, Progress, and Prospects of Developing Therapies to Treat Autoimmune Diseases. Cell. 2020;181(1):63-80. doi:10.1016/j.cell.2020.03.007
  • 15. Ahmed AB, Chetia P. Selegiline modulates inflammatory indicators in RAW 264.7 macrophages and LPS-aggravated CFA-induced rheumatoid arthritis in rats. Eur J Clin Exp Med. 2024;22(1):6-16. doi:10.15584/ejcem.2024.1.12
  • 16. Chetia P, Khandelwal B, Haldar PK, Bala A. Dietary Antioxidants Significantly Reduced Phorbol Myristate Acetate Induced Oxidative Stress of Peripheral Blood Mononuclear Cells of Patients with Rheumatoid Arthritis. Curr Rheumatol Rev. 2020;17(1):81-87. doi:10.2174/1573397116999200729154954
  • 17. Almoallim H, Al Saleh J, Badsha H, Ahmed HM, Habjoka S, Menassa JA, et al. A Review of the Prevalence and Unmet Needs in the Management of Rheumatoid Arthritis in Africa and the Middle East. Rheumatol Ther. 2021;8(1):1-16. doi:10.1007/s40744-020-00252-1
  • 18. Watanabe R, Okano T, Gon T, Yoshida N, Fukumoto K, Yamada S, et al. Difficult-to-treat rheumatoid arthritis: Current concept and unsolved problems. Front Med. 2022;9:1049875. doi:10.3389/fmed.2022.1049875
  • 19. Balogh L, Oláh K, Sánta S, Majerhoffer N, Németh T. Novel and potential future therapeutic options in systemic autoimmune diseases. Front Immunol. 2024;15(March):1-16. doi:10.3389/fimmu.2024.1249500
  • 20. Filgueiras MS, Rocha NP, Novaes JF, Bressan J. Vitamin D status, oxidative stress, and inflammation in children and adolescents: A systematic review. Crit Rev Food Sci Nutr. 2020;60(4):660-669. doi:10.1080/10408398.2018.1546671
  • 21. Guan Y, Hao Y, Guan Y, Bu H, Wang H. The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Front Med. 2020;7(October):1-11. doi:10.3389/fmed.2020.596007
  • 22. Martinez-Prat L, Nissen MJ, Lamacchia C, Bentow C, Cesana L, Roux-Lombard P, et al. Comparison of Serological Biomarkers in Rheumatoid Arthritis and Their Combination to Improve Diagnostic Performance. Front Immunol. 2018;9:1113. doi:10.3389/fimmu.2018.01113
  • 23. Ingegnoli F, Castelli R, Gualtierotti R. Rheumatoid factors: clinical applications. Dis Markers. 2013;35(6):727-734. doi:10.1155/2013/726598
  • 24. Kay J, Upchurch KS. ACR/EULAR 2010 rheumatoid arthritis classification criteria. Rheumatology. 2012;51(suppl_6):vi5-vi9. doi:10.1093/rheumatology/kes279
  • 25. Trier NH, Holm BE, Hansen PR, Slot O, Locht H, Houen G. Specificity of Anti-Citrullinated Protein Antibodies in Rheumatoid Arthritis. Antibodies. 2019;8(2). doi:10.3390/antib8020037
  • 26. Sproston NR, Ashworth JJ. Role of C-Reactive Protein at Sites of Inflammation and Infection. Front Immunol. 2018;9:754. doi:10.3389/fimmu.2018.00754
  • 27. Abdelhafiz D, Baker T, Glascow DA, Abdelhafiz A. Biomarkers for the diagnosis and treatment of rheumatoid arthritis – a systematic review. Postgrad Med. 2023;135(3):214-223. doi:10.1080/00325481.2022.2052626
  • 28. Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum. 2021;51(1):219-229. doi:10.1016/j.semarthrit.2020.11.005
  • 29. Johnson TM, Register KA, Schmidt CM, O'Dell JR, Mikuls TR, Michaud K, et al. Correlation of the Multi-Biomarker Disease Activity Score With Rheumatoid Arthritis Disease Activity Measures: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2019;71(11):1459-1472. doi:10.1002/acr.23785
  • 30. Meznerics FA, Kemény LV, Gunther E, Bakó E, Dembrovszky F, Szabó B, et al. Multibiomarker disease activity score: an objective tool for monitoring rheumatoid arthritis? A systematic review and meta-analysis. Rheumatology. 2023;62(6):2048-2059. doi:10.1093/rheumatology/keac715
  • 31. Shoenfeld N, Amital H, Shoenfeld Y. The effect of melanism and vitamin D synthesis on the incidence of autoimmune disease. Nat Clin Pract Rheumatol. 2009;5(2):99-105. doi:10.1038/ncprheum0989
  • 32. Khashim Alswailmi F, Shah SIA, Nawaz H, Al-Mazaideh GM. Molecular Mechanisms of Vitamin D-Mediated Immunomodulation. Galen Med J. 2021;10:e2097. doi:10.31661/gmj.v10i0.2097
  • 33. Samanta S. Vitamin D and immunomodulation in the skin: a useful affirmative nexus. Explor Immunol. 2021:90-111. doi:10.37349/ei.2021.00009
  • 34. Galoppin M, Kari S, Soldati S, Pal A, Rival M, Engelhardt B, et al. Full spectrum of vitamin D immunomodulation in multiple sclerosis: mechanisms and therapeutic implications. Brain Commun. 2022;4(4):171. doi:10.1093/braincomms/fcac171
  • 35. Giannini S, Giusti A, Minisola S, Napoli N, Passeri G, Rossini M, et al. The Immunologic Profile of Vitamin D and Its Role in Different Immune-Mediated Diseases: An Expert Opinion. Nutrients. 2022;14(3):473. doi:10.3390/nu14030473
  • 36. Sîrbe C, Rednic S, Grama A, Pop TL. An Update on the Effects of Vitamin D on the Immune System and Autoimmune Diseases. Int J Mol Sci. 2022;23(17). doi:10.3390/ijms23179784
  • 37. Streeter HB, Wraith DC. Manipulating antigen presentation for antigen-specific immunotherapy of autoimmune diseases. Curr Opin Immunol. 2021;70:75-81. doi:10.1016/j.coi.2021.03.019
  • 38. Jones G. 100 YEARS OF VITAMIN D: Historical aspects of vitamin D. Endocr Connect. 2022;11(4):e210594. doi:10.1530/EC-21-0594
  • 39. Agliardi C, Guerini FR, Bolognesi E, Zanzottera M, Clerici M. VDR Gene Single Nucleotide Polymorphisms and Autoimmunity: A Narrative Review. Biology (Basel). 2023;12(7):916. doi:10.3390/biology12070916.
  • 40. Ekimoto T, Kudo T, Yamane T, Ikeguchi M. Mechanism of Vitamin D Receptor Ligand-Binding Domain Regulation Studied by gREST Simulations. J Chem Inf Model. 2021;61(7):3625-3637. doi:10.1021/acs.jcim.1c00534
  • 41. Zhang L, Zhang S, He C, Wang X. VDR Gene Polymorphisms and Allergic Diseases: Evidence from a Meta-analysis. Immunol Invest. 2020;49(1-2):166-177. doi:10.1080/08820139.2019.1674325
  • 42. Al Haj Mahmoud SA, Atoum MF, Al-Hourani HM, Bateineh S, Abderrahman S, Alzoughool F. Vitamin D deficiency and rs731236(Taq1) vitamin D receptor gene polymorphism as possible risk factors for rheumatoid arthritis and osteoarthritis. Acta Medica Mediterr. 2018;34(1). doi:10.19193/0393-6384_2018_1_34
  • 43. Rodríguez-Carrio J, Alperi-López M, Naves-Díaz M, Dusso A, López P, Ballina-García FJ, et al. Vitamin D Receptor Polymorphism and DHCR7 Contribute to the Abnormal Interplay Between Vitamin D and Lipid Profile in Rheumatoid Arthritis. Sci Rep. 2019;9(1):1-11. doi:10.1038/s41598-019-38756-8
  • 44. Márquez Pete N, Pérez Ramírez C, Maldonado Montoro MDM, Martínez Martínez F, Fernández-Llimos F, Sánchez Pozo A, et al. Association of vitamin D receptor gene polymorphisms with rheumatoid arthritis. Arch Med Sci. 2021. doi:10.5114/aoms/116606
  • 45. Mohammed LA, Baraka AM, Nageeb GS, Alsayed FM, Ahmed AM, Soliman AS, et al. Vitamin d receptor foki gene polymorphism in rheumatoid arthritis patients. Egypt J Hosp Med. 2021;85(1):2777-2784. doi:10.21608/EJHM.2021.189936
  • 46. Ahmad HM, Zaki ZM, Mohamed AS, Ahmed AE. Biochemical markers and FokI and TaqI vitamin D receptor genes polymorphism in rheumatoid arthritis. BMC Med Genomics. 2023;16(1):1-9. doi:10.1186/s12920-023-01668-8
  • 47. Zhang TP, Li HM, Huang Q, Wang L, Li XM. Vitamin D Metabolic Pathway Genes Polymorphisms and Their Methylation Levels in Association With Rheumatoid Arthritis. Front Immunol. 2021;12(December):1-12. doi:10.3389/fimmu.2021.731565
  • 48. Ahmad HM, Zaki ZM, Mohamed AS, Ahmed AE. Genetic Risk of Rheumatoid Arthritis: A Case Control Study. Biochem Genet. 2023. doi:10.1007/s10528-023-10648-7
  • 49. Mukhtar M, Sheikh N, Suqaina SK, Batool A, Fatima N, Mehmood R, et al. Vitamin D Receptor Gene Polymorphism: An Important Predictor of Arthritis Development. Biomed Res Int. 2019;2019:8326246. doi:10.1155/2019/8326246
  • 50. Abdelnaser N, Abdul Basset S, Elkhouly R, Mahdy H, Ibrahim A. Vitamin D Level in Rheumatoid Arthritis Patients in Saudi Arabia and Its Correlation With Disease Activity and Mood Changes. Benha Med J. 2023; 40(2): 317-332. doi: 10.21608/bmfj.2022.174640.1707
  • 51. Zahir EOM, Hp F, Syahriani F, Bakri S, Aman AM. Association Between Level of Vitamin D with Degree of Disease Activity in Rheumatoid Arthritis. 2023;63(02):7417-7423.
  • 52. Moulton VR. Sex Hormones in Acquired Immunity and Autoimmune Disease. Front Immunol. 2018;9:2279. doi:10.3389/fimmu.2018.02279
  • 53. Meena N, Singh Chawla SP, Garg R, Batta A, Kaur S. Assessment of Vitamin D in Rheumatoid Arthritis and Its Correlation with Disease Activity. J Nat Sci Biol Med. 2018;9(1):54-58. doi:10.4103/jnsbm.JNSBM_128_17
  • 54. Sukharani N, Dev K, Rahul F, Bai P, Ali A, Avinash F, et al. Association Between Rheumatoid Arthritis and Serum Vitamin D Levels. Cureus. 2021;13(9):24-27. doi:10.7759/cureus.18255
  • 55. Punceviciene E, Gaizevska J, Sabaliauskaite R, Venceviciene L, Puriene A, Vitkus D, et al. Vitamin d and vdr gene polymorphisms’ association with rheumatoid arthritis in lithuanian population. Med. 2021;57(4):1-12. doi:10.3390/medicina57040346
  • 56. Alharbi S, Alharbi R, Alhabib E, Ghunaim R, Alreefi MM. Vitamin D Deficiency in Saudi Patients With Rheumatoid Arthritis. Cureus. 2023;15(2). doi:10.7759/cureus.34815
  • 57. Soltani Bajestani F, Khajavian N, Salarbashi D, Kafili M, Ashori F, Hajavi J. Relationship Between Serum Vitamin D Level and Disease Severity in Rheumatoid Arthritis. Clin Med Insights Arthritis Musculoskelet Disord. 2023;16:11795441231182997. doi:10.1177/11795441231182997
  • 58. Mustafa Mohamed ME, Taha ZI, Hamza SB, Abdalla YA, Noor SK, William J. Vitamin D Levels Among Rheumatoid Arthritis Sudanese Patients: Prevalence and Correlation to Disease Activity – A Bicentric Study. Open Access Rheumatol Res Rev. 2023;15:181-187. doi:10.2147/OARRR.S425397
  • 59. Mouterde G, Gamon E, Rincheval N, Lukas C, Seror R, Berenbaum F, et al. Association between Vitamin D deficiency and disease activity, disability, and radiographic progression in early rheumatoid arthritis: The ESPOIR cohort. J Rheumatol. 2020;47(11):1624-1628. doi:10.3899/jrheum.190795
  • 60. Hahn J, Cook NR, Alexander EK, Friedman S, Walter J, Bubes V, et al. Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ. 2022;376:e066452. doi:10.1136/bmj-2021-066452
  • 61. Soubrier M, Lambert C, Combe B, Gaudin P, Thomas T, Sibilia J, et al. A randomised, double-blind, placebo-controlled study assessing the efficacy of high doses of vitamin D on functional disability in patients with rheumatoid arthritis. Clin Exp Rheumatol. 2018;36(6):1056-1060.
  • 62. Alabdulwahed RA, Khoja SO, Elshal MF, Bahlas SMA, Alghamdi SA, Khojah SM. Modulation of CD28 and p38 Expression by Treatment with Vitamin D in Patients with Rheumatoid Arthritis. J Biochem Tech. 2019;10:76-82.
  • 63. Mukherjee D, Lahiry S, Thakur S, Chakraborty DS. Effect of 1,25 dihydroxy vitamin D3 supplementation on pain relief in early rheumatoid arthritis. J Family Med Prim Care. 2019;8(2):517-522. doi:10.4103/jfmpc.jfmpc_446_18
  • 64. El-banna HS, Gado SE. Vitamin D : Does It Help Tregs in Active Rheumatoid Arthritis. Expert Rev Clin Immunol. 2020;16(8):847-853. doi:10.1080/1744666X.2020.1805317
  • 65. Franco AS, Freitas TQ, Bernardo WM, Pereira RMR. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis. Medicine (Baltimore). 2017;96(23):e7024. doi:10.1097/MD.0000000000007024
  • 66. Lin J, Liu J, Davies ML, Chen W. Serum Vitamin D level and rheumatoid arthritis disease activity: Review and meta-analysis. PLoS One. 2016;11(1):1-17. doi:10.1371/journal.pone.0146351
  • 67. Ishikawa LLW, Colavite PM, Fraga-Silva TFC, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D Deficiency and Rheumatoid Arthritis. Clin Rev Allergy Immunol. 2017;52(3):373-388. doi:10.1007/s12016-016-8577-0
  • 68. Ao T, Kikuta J, Ishii M. The Effects of Vitamin D on Immune System and Inflammatory Diseases. Biomolecules. 2021;11(11). doi:10.3390/biom11111624
  • 69. Song GG, Bae SC, Lee YH. Association between vitamin D intake and the risk of rheumatoid arthritis: A meta-analysis. Clin Rheumatol. 2012;31(12):1733-1739. doi:10.1007/s10067-012-2080-7
  • 70. Carlberg C, Raczyk M, Zawrotna N. Vitamin D: A master example of nutrigenomics. Redox Biol. 2023;62:102695. doi:10.1016/j.redox.2023.102695
  • 71. Bellan M, Andreoli L, Nerviani A, Piantoni S, Avanzi GC, Soddu D, et al. Is cholecalciferol a potential disease-modifying anti-rheumatic drug for the management of rheumatoid arthritis? Clin Exp Rheumatol. 2020;38(2):343-349. doi: 10.55563/clinexprheumatol/tdf172.
  • 72. Donati S, Palmini G, Aurilia C, Falsetti I, Miglietta F, Iantomasi T, et al. Rapid Nontranscriptional Effects of Calcifediol and Calcitriol. Nutrients. 2022;14(6):1291. doi: 10.3390/nu14061291.
  • 73. Luo Y, Qu C, Zhang R, Zhang J, Han D, Na L. Geographic location and ethnicity comprehensively influenced vitamin D status in college students: a cross-section study from China. J Health Popul Nutr. 2023 Dec 20;42(1):145. doi: 10.1186/s41043-023-00488-x.
  • 74. Choudhury C, Sahib A, Karmakar P, Kar S. Correlation of Serum Vitamin D and High-Density Lipoprotein (HDL) Cholesterol Levels With Disease Activity in Rheumatoid Arthritis: A Single-Center Experience From Eastern India. Cureus. 2024 Sep 13;16(9):e69333. doi: 10.7759/cureus.69333
There are 74 citations in total.

Details

Primary Language English
Subjects Basic Pharmacology
Journal Section Review Articles
Authors

Mousumi Borgohain This is me 0009-0003-6564-8924

Purbajit Chetia 0000-0001-8153-8942

Lakshyajeet Nath This is me 0000-0001-9575-7732

Chayanika Kalita This is me 0000-0001-5090-1286

Publication Date September 1, 2025
Submission Date October 26, 2024
Acceptance Date August 4, 2025
Published in Issue Year 2025 Volume: 45 Issue: 3

Cite

Vancouver Borgohain M, Chetia P, Nath L, Kalita C. Vitamin D as an Adjuvant in Rheumatoid Arthritis: A Systematic Review of Existing Literature. HUJPHARM. 2025;45(3):255-67.