REVIEW - Clinical aspects of vitamin D in the management of RA

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Rheumatology Advance Access originally published online on August 5, 2008

Rheumatology 2008 47(11):1617-1621; doi:10.1093/rheumatology/ken296

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REVIEWS

Clinical aspects of vitamin D in the management of rheumatoid arthritis

P. Leventis1 and S. Patel1,2

1Department of Rheumatology, St Helier University Hospital, Carshalton

and 2Department of Cellular and Molecular Medicine, St 's,

University of London, London, UK.

Abstract

There is an increasing interest in the role of vitamin D as a

potential treatment for a number of disparate diseases. In addition to

its role in calcium homeostasis, vitamin D has a plethora of effects

including immunomodulation, pleiotropic effects, modulating propensity

to infection and blood pressure regulation. Detection and treatment of

vitamin D deficiency in selected patients with RA is relevant as

deficiency is common. Vitamin D therapy may modify the increased risk

of falls and fracture in this group, and possibly exert additional

immunomodulatory effects on disease onset and activity although data

are largely epidemiological. Currently, there is no consensus view on

vitamin D replacement regimens, nor an agreed optimal level of serum

25-hydroxyvitamin D [25(OH)D] for health. Indeed levels may vary for

different organ systems and the concept of 'tissue specific vitamin D

deficiency' needs to be considered. Therefore, there is clinical

uncertainty regarding both when and how to correct vitamin D

deficiency. Older patients, particularly post-menopausal women, and

others at high risk of vitamin D deficiency should be preferentially

targeted since they are likely to benefit most from supplementation.

Clinicians should be aware of the technical difficulties associated

with measuring and interpreting 25(OH)D levels. The administration of

high-dose vitamin D as an oral weekly bolus is safe and can rapidly

correct vitamin D deficiency followed by regular lower doses to

maintain adequate levels.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/47/11/1617?etoc

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