The Importance of 25 Hydroxyvitamin D Level Monitoring in Children Diagnosed with Juvenile Idiopathic Arthritis

Year 2024, , 83 - 87, 14.03.2024

Ülkü Miray Yıldırım , Müferet Ergüven

https://doi.org/10.18521/ktd.1394091

Abstract

Objective: In patients with juvenile idiopathic arthritis (JIA), bone metabolism may be negatively affected due to both the activity of the disease and the medications used. Our study aimed to investigate the necessity of evaluating 25 hydroxyvitamin D (25 (OH) Vit D), calcium (Ca), phosphorus (P), alkaline phosphatase (ALP) levels and possible related factors in the follow-up of patients diagnosed with JIA.
Method: The records of 68 patients with JIA were retrospectively evaluated. Disease subtypes, medications used, and whether they were in remission or active disease were reviewed.
Results: 25 OH Vit D levels were low in 14.7% of patients with JIA compared to the control group. 66.6% of the patients with systemic arthritis had high ALP levels. 25 OH Vit D level was low in 16.6% of steroid users, and Vitamin D level was low in 55.5% of the patients in the active disease group. It was determined that patients in the active disease group had the highest ALP and lowest vitamin D levels compared to patients in remission with and without medication.
Conclusion: Bone metabolism in patients with JIA is negatively affected. Since vitamin D plays a crucial role in bone metabolism, it was emphasized that vitamin D levels should be evaluated especially during active disease and supplements should be provided for patients with low vitamin D levels.

Keywords

Juvenile idiopathic arthritis, vitamin D, bone metabolism

Juvenil İdiyopatik Artrit Tanılı Çocuklarda 25 Hidroksivitamin D Düzey Takibinin Önemi

Abstract

Amaç: Juvenil idiyopatik artrit (JİA)’li hastalarda gerek hastalığın aktivitesi gerekse kullanılan ilaçlar nedeni ile kemik metabolizması olumsuz etkilenebilir. Çalışmamızda JİA tanılı hastaların takibinde 25 hidroksivitamin D (25 (OH) Vit D), kalsiyum (Ca), fosfor (P), alkalen fosfataz (ALP) düzeyleri ve ilişkili olabilecek faktörlerin değerlendirilmesinin gerekliliğini araştırmak amaçlandı
Metod: JİA tanılı 68 hastanın kayıtları retrospektif olarak değerlendirildi. Hastalık alt tipleri, remisyon durumu, kullanılan ilaçlar incelendi.
Bulgular: Kontrol grubuna kıyasla JİA hastalarının %14,7’sinde vitamin D düzeyinin düşük olduğu bulundu. Sistemik artriti olan hastaların %66,6’sında ALP düzeyinin yüksek olduğu saptandı. Steroid kullananların %16,6’sında vitamin D düzeyi düşük bulundu. İlaçlı ve ilaçsız remisyondaki hastalarla kontrol grubu arasında biyokimyasal parametreler açısından fark yoktu. Aktif hastalık grubundaki hastaların %55,5’inde vitamin D düzeyleri düşük saptandı. Aktif hastalık grubundaki hastaların, ilaçlı ve ilaçsız remisyondaki hastalar ile karşılaştırıldığında, en yüksek ALP ve en düşük vitamin D düzeyine sahip oldukları saptandı.
Sonuç: JİA’lı hastalarda kemik metabolizması olumsuz etkilenmektedir. D vitamininin kemik metabolizması üzerinde önemli rol oynaması nedeni ile bu hasta grubunda özellikle aktif hastalık sırasında vitamin D düzeylerinin bakılması ve D vitamini düşük saptanan hastalara vitamin D desteği verilmesi gerekliliği vurgulandı.

Keywords

: Juvenil idiyopatik artrit, D vitamini, kemik metabolizması

References

• 1. Bansal N, Pasricha C, Kumari P, Jangra S, Kaur R, Singh R. A comprehensive overview of juvenile idiopathic arthritis: From pathophysiology to management. Autoimmun Rev. 2023;22(7):103337.
• 2. Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine. 2014;81(2):112-7.
• 3.Ozen S, Karaaslan Y, Ozdemir O, Saatci U, Bakkaloglu A, Koroglu E, et al. Prevalence of juvenile chronic arthritis and familial Mediterranean fever in Turkey: a field study. J Rheumatol. 1998;25(12):2445-9.
• 4. Rigante D, Bosco A, Esposito S. The etiology of juvenile idiopathic arthritis. Clin Rev Allergy Immunol. 2015;49:253-61.
• 5. Jang S, Kwon EJ, Lee JJ. Rheumatoid Arthritis: Pathogenic Roles of Diverse Immune Cells. Int J Mol Sci. 2022;23(2):905.
• 6.Mesci N, Külcü DG. Relationship Between Serum 25-Hydroxy Vitamin D Level and Disease Activity in Patients with Rheumatoid Arthritis. Haydarpasa Numune Med J 2017;57(2):78–82.
• 7.Warady BD, Lindsley CB, Robinson FG, Lukert BP. Effects of nutritional supplementation on bone mineral status of children with rheumatic diseases receiving corticosteroid therapy. J Rheumatol. 1994;21(3):530-5.
• 8.Stapleton FB, Hanissian AS, Miller LA. Hypercalciuria in children with juvenile rheumatoid arthritis: association with hematuria. J Pediatr. 1985;107(2):235-9. 9. Di Marcello F, Di Donato G, d'Angelo DM, Breda L, Chiarelli F. Bone Health in Children with Rheumatic Disorders: Focus on Molecular Mechanisms, Diagnosis, and Management. Int J Mol Sci. 2022;23(10):5725. 10.Reeve J, Loftus J, Hesp R, Ansell BM, Wright DJ, Woo PM. Biochemical prediction of changes in spinal bone mass in juvenile chronic (or rheumatoid) arthritis treated with glucocorticoids. J Rheumatol. 1993;20(7):1189-95. 11. Charuvanij S, Malakorn H, Densupsoontorn N, Nakavachara P. Bone Mineral Density and Serum 25OHD in Children and Adolescents With Juvenile Idiopathic Arthritis. Clinical Pediatrics. 2023;62(5):456-65.
• 12. Yang H, Lan C, Xie J, Xun C, Wang M, Rong K, et al. Effects of methotrexate combined with tocilizumab on growth and bone metabolism in children with juvenile idiopathic arthritis. Am J Transl Res. 2023;15(5):3530-8.
• 13.Henderson CJ, Cawkwell GD, Specker BL, Sierra RI, Wilmott RW. Predictors of total body bone mineral density in non-corticosteroid –treated prepubertal children with juvenile rheumatoid arthritis. Arthritis Rheum. 1997; 40:1967-75.
• 14.Çomak E, Doğan ÇS, Uslu-Gökçeoğlu A, Akbaş H, Özdem S, Koyun M, et al. Association between vitamin D deficiency and disease activity in juvenile idiopathic arthritis. Turk J Pediatr. 2014;56(6):626-31.
• 15.Tangcheewinsirikul S, Sukharomana M, Charuvanij S. Disability and disease-related damage in Thai children and adolescents with juvenile idiopathic arthritis. Pediatr Rheumatol. 2023;21:68.
• 16.Stagi S, Masi L, Capannini S, Cimaz R, Tonini G, Matucci-Cerinic M, et al. Cross-sectional and longitudinal evaluation of bone mass in children and young adults with juvenile idiopathic arthritis: the role of bone mass determinants in a large cohort of patients. J Rheumatol. 2010;37(9):1935-43.
• 17.Lien G, Flato B, Haugen M, Vinje O, Dale K. Frequency of osteopenia in adolescents with early –onset juvenile idiopathic arthritis: a long-term outcome study of one hundred five patients. Arthritis Rheum. 2003;48:2214-23.