The Effect of Vitamin D Deficiency on Disease Activity, Physical Function, Health-Related Quality of Life and Psychiatric Status in Patients with Axial Spondyloarthritis

Abstract

Objective: IAxial spondyloarthritis (axSpA) is a heterogeneous group of inflammatory diseases characterized by predominant involvement of the axial skeleton. Vitamin D deficiency is not a
rare situation in the world. The aim of this study was to assess the relationship between vitamin D deficiency and disease activity measures, health related quality of life (QoL) and
other clinical characteristics in patients with axSpA.
Method: Disease activity, functions, mobility, QoL and pain were assessed by using questionnaires and blood samples was collected for vitamin D levels in patients with axSpA.
Results: A total 25patients with ankylosing spondylitis (AS) and 25 non-radiographic (nr) axSpA were included. Mean age of AS and nr-axSpA was similar. Forty four percent of patients with
axSpA had vitamin D deficiency. Mean vitamin D levels were significantly lower in patients with nr-axSpA than AS. Some disease activity measurements were higher in patients with
axSpA who had vitamin D deficiency.
Conclusion: Quality of life measures were similar between the groups. There were low negative relationships between vitamin D level and Bath Ankylosing Spondylitis Functional Index, Bath
Ankylosing Spondylitis Metrology Index and Bath Ankylosing Spondylitis Disease Activity Index

Keywords

• Axial spondyloarthritis
• vitamin D
• physical function
• disease activity

D Vitamini Eksikliğinin Aksiyel Spondiloartritli Hastalarda Hastalık Aktivitesi, Fiziksel Fonksiyonlar, Sağlıkla İlgili Yaşam Kalitesi ve Psikiyatrik Durum Üzerine Etkisi

Abstract

Amaç: Aksiyel spondiloartrit (aksSpA), aksiyel iskeletin baskın tutulumu ile karakterize heterojen bir inflamatuvar hastalık grubudur. D vitamini eksikliği dünyada ender bir durum değildir. Bu çalışmanın amacı, axSpA hastalarında D vitamini eksikliği ile hastalık aktivitesi, sağlıkla ilişkili yaşam kalitesi ve diğer klinik özellikler arasındaki ilişkiyi değerlendirmektir.

Gereç ve Yöntemler: Hastalık aktivitesi, fonksiyonlar, mobilite, yaşam kalitesi ve ağrı çeşitli indekslerle değerlendirildi ve aksSpA'lı hastalarda vitamin D düzeyleri için kan örnekleri toplandı.

Bulgular: Toplam 25 ankilozan spondilit (AS), 25 radyografik olmayan (nr) aksSpA’lı hasta dâhil edildi. AS ve nr-aksSpA'lı hastaların yaş ortalaması benzerdi. AksSpA’lı hastaların %44'ünde D vitamini eksikliği vardı. Ortalama vitamin D düzeyleri, nr-aksSpA'lı hastalarda AS’li hastalardan anlamlı olarak daha düşüktü. D vitamini eksikliği olan aksSpA’lı hastalarda bazı hastalık aktivite ölçekleri daha yüksekti.

Sonuç: Yaşam kalitesi ölçütleri gruplar arasında benzerdi. D vitamini düzeyi ile Bath Ankilozan Spondilit Fonksiyonel İndeksi (BASFI), Bath Ankilozan Spondilit Metroloji İndeksi (BASMI) ve Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAI) arasında düşük negatif ilişki vardı.

Keywords

• Aksiyel spondiloartrit
• D vitamini
• fiziksel fonksiyon
• hastalık aktivitesi

References

1. Referans1 Dougados M, Baeten D. Spondyloarthritis. Lancet 2011;377:2127-37.
2. Referans2 Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 2009;68:777-83.
3. Referans3 Holick MF. Vitamin D deficiency. N Engl J Med 2007;357:266-81.
4. Referans4 Giovannucci E. Vitamin D and cancer incidence in the Harvard cohorts. Ann Epidemiol 2009;19:84-8.
5. Referans5 Jenab M, Bueno-de-Mesquita HB, Ferrari P, van Duijnhoven FJ, Norat T, Pischon T, et al. Association between pre-diagnostic circulating vitamin D concentration and risk of colorectal cancer in European populations:a nested case-control study. BMJ 2010;340:b5500.
6. Referans6 Bauer SR, Hankinson SE, Bertone-Johnson ER, Ding EL. Plasma vitamin D levels, menopause, and risk of breast cancer: dose-response meta-analysis of prospective studies. Medicine (Baltimore) 2013;92:123-31.
7. Referans7 Wang L, Song Y, Manson JE, Pilz S, Marz W, Michaelsson K, et al. Circulating 25-hydroxy-vitamin D and risk of cardiovascular disease: a meta-analysis of prospective studies. Circ Cardiovasc Qual Outcomes 2012;5:819-29.
8. Referans 8 Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr 2008;88:558S-64S.

9. Referans 9 Zhao S, Duffield SJ, Moots RJ, Goodson NJ. Systematic review of association between vitamin D levels and susceptibility and disease activity of ankylosing spondylitis. Rheumatology (Oxford) 2014;53:1595-603.
10. Referans 10 Akkoc Y, Karatepe AG, Akar S, Kirazli Y, Akkoc N. A Turkish version of the Bath Ankylosing Spondylitis Disease Activity Index: reliability and validity. Rheumatol Int 2005;25:280-4.
11. Referans 11 van der Heijde D, Lie E, Kvien TK, Sieper J, Van den Bosch F, Listing J, et al. ASDAS, a highly discriminatory ASAS-endorsed disease activity score in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68:1811-8.
12. Referans 12 Yanik B, Gursel YK, Kutlay S, Ay S, Elhan AH. Adaptation of the Bath Ankylosing Spondylitis Functional Index to the Turkish population, its reliability and validity: functional assessment in AS. Clin Rheumatol 2005;24:41-7.
13. Referans 13 Jenkinson TR, Mallorie PA, Whitelock HC, Kennedy LG, Garrett SL, Calin A. Defining spinal mobility in ankylosing spondylitis (AS). The Bath AS Metrology Index. J Rheumatol 1994;21:1694-8.
14. Referans 14 Duruoz MT, Doward L, Turan Y, Cerrahoglu L, Yurtkuran M, Calis M, et al. Translation and validation of the Turkish version of the Ankylosing Spondylitis Quality of Life (ASQOL) questionnaire. Rheumatol Int 2013;33:2717-22.
15. Referans 15 Ponsonby AL, McMichael A, van der Mei I. Ultraviolet radiation and autoimmune disease: insights from epidemiological research. Toxicology 2002;181-182:71-8.
16. Referans 16 Group G-R. Latitude gradient influences the age of onset of rheumatoid arthritis: a worldwide survey. Clin Rheumatol 2017;36:485-97.
17. Referans 17 Mathieu A, Paladini F, Vacca A, Cauli A, Fiorillo MT, Sorrentino R. The interplay between the geographic distribution of HLA-B27 alleles and their role in infectious and autoimmune diseases: a unifying hypothesis. Autoimmun Rev 2009;8:420-5.
18. Referans 18 Braun-Moscovici Y, Toledano K, Markovits D, Rozin A, Nahir AM, Balbir-Gurman A. Vitamin D level: is it related to disease activity in inflammatory joint disease? Rheumatol Int 2011;31:493-9.
19. Referans 19 Yazmalar L, Ediz L, Alpayci M, Hiz O, Toprak M, Tekeoglu I. Seasonal disease activity and serum vitamin D levels in rheumatoid arthritis, ankylosing spondylitis and osteoarthritis. Afr Health Sci 2013;13:47-55.
20. Referans 20 Dougados M, d'Agostino MA, Benessiano J, Berenbaum F, Breban M, Claudepierre P, et al. The DESIR cohort: a 10-year follow-up of early inflammatory back pain in France: study design and baseline characteristics of the 708 recruited patients. Joint Bone Spine 2011;78:598-603.
21. Referans 21 Rudwaleit M, Haibel H, Baraliakos X, Listing J, Marker-Hermann E, Zeidler H, et al. The early disease stage in axial spondylarthritis: results from the German Spondyloarthritis Inception Cohort. Arthritis Rheum 2009;60:717-27.
22. Referans 22 Kiltz U, Baraliakos X, Karakostas P, Igelmann M, Kalthoff L, Klink C, et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken) 2012;64:1415-22.
23. Referans 23 Kilic G, Kilic E, Ozgocmen S. Relationship between psychiatric status, self-reported outcome measures, and clinical parameters in axial spondyloarthritis. Medicine (Baltimore) 2014;93:e337.
24. Referans 24 Hmamouchi I, Paternotte S, Molto A, Etcheto A, Borderie D, Combe B, et al. Vitamin D, disease activity and comorbidities in early spondyloarthritis. Clin Exp Rheumatol 2016;34:396-403.
25. Referans 25 Kilic E, Ozgocmen S. Bone mass in axial spondyloarthritis: A literature review. World J Orthop 2015;6:298-310.
26. Referans 26 Gratacos J, Collado A, Pons F, Osaba M, Sanmarti R, Roque M, et al. Significant loss of bone mass in patients with early, active ankylosing spondylitis: a followup study. Arthritis Rheum 1999;42:2319-24.
27. Referans 27 Arends S, Spoorenberg A, Bruyn GA, Houtman PM, Leijsma MK, Kallenberg CG, et al. The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis. Osteoporos Int 2011;22:14