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Healing Choices for RA, Issue #018 --Low vitamin D reduces response to treatment
May 01, 2015

Low Vitamin D levels reduce responses to treatment for rheumatoid arthritis

At least 3 of every 4 rheumatoid arthritis patients have low levels of vitamin D.[1, 2] People with vitamin D levels less than 20ng/mL (<50nmol/L) are considered deficient and those with vitamin D levels less than 29ng/mL (less than 72.5nmol/L)) have insufficient Vitamin D levels. Rheumatoid arthritis patients with very low vitamin D levels (less than 20ng/mL) experienced worse disease symptoms, including: greater pain, longer morning stiffness, more tender joints, more swollen joints, higher levels of inflammatory markers, worse Disease activity score, more physical disability, more fatigue [2], and a higher tendency towards depression. [1]

Conversely, arthritis patients with higher vitamin D levels participated in more physical activities. [1]

How vitamin D helps maintain bone health

Vitamin D helps the stomach absorb calcium and transport it to bones. Vitamin K and vitamin D are essential for using the calcium to build and repair bones.

Vitamin D helps maintain a balanced immune response

Vitamin D boosts immune responses to flu (influenza) and to bacteria. Vitamin D also boosts the ability of macrophages and dendritic cells to scavenge dead and dying cells and bacterial debris. Infection with some bacteria increases the number of vitamin D receptors on cells.

Vitamin D displays anti-anti-inflammatory activity and helps maintain a balanced immune response. That is, when the healing process needs to turn off inflammation, vitamin D helps the cells receive and accept the signal.

Early RA patients with very low vitamin D do not respond as thoroughly to treatment

Cavallo and colleagues investigated whether vitamin D levels in early RA patients affected the response to treatment with methotrexate and prednisolone during the first year.[3] They checked the medical charts of 37 RA patients at 12 months.

They compared each patient’s lab results, their joints, and pain levels at initial diagnosis to 12 months. They grouped the RA patients by vitamin D levels: RA patients with very low vitamin D levels at diagnosis (less than 20ng/L) vs RA patients with higher vitamin D levels (greater than 20ng/L). [3]

The treatments lowered the markers of inflammation in the blood about the same in both groups.

In contrast, RA patients with higher vitamin D levels responded better to treatment for clinical symptoms than RA patients with the very low vitamin D levels:

Morning stiffness declined 93% to an average of 7 min in RA patients with higher vitamin D levels. Morning stiffness only declined 32.4% with an average 38 min of morning stiffness in RA patients with very low vitamin D. Big significant difference—7 min with higher vitamin D vs 38 min with very low vitamin D.[3]

Pain levels declined significantly more, too! Patient-described pain went down 66% in the group with higher vitamin D levels but only went down 16% in the very low vitamin D group.[3]

The number of swollen and tender joints also went down more in the higher vitamin D group.

Most RA patients in the higher vitamin D group had initially 5.5 swollen joints and 7.5 tender joints. After 1 year with treatment, most of the higher vitamin D group had no swollen or tender joints although some people (less than half) had some tender joints after treatment.

In contrast, most RA patients in the very low vitamin D group had initially 7 joints and after 1 year with treatment, still had at least 3 swollen joints and at least 1 tender joint.[3] All the patients with higher vitamin D responded to treatment (good responders or moderate responders). In contrast, one in four RA patients with very low vitamin D levels did not respond at all to treatment.

Thus, if you’re recently diagnosed with RA, consider the following five tips.

Bottom line: check your vitamin D levels

Keep vitamin D levels at least 20ng/L, preferably greater than 30ng/mL. 5 Tips:

1. Have your vitamin D levels checked.

2. Spend time outside—at least 20-30 min per day during the sunny time—so your skin can absorb sunlight and make vitamin D. Allow your skin to get a very light pink from sunlight exposure, if ok with your healthcare practitioners.

3. Consider a full spectrum daylight light bulb for the rooms where you spend the most time.

4. Avoid most tanning salons as the proportion of each wavelength is different than natural sunlight. For example, ultraviolet light A induces the tan but degrades vitamin D. Ultraviolet light B converts the cholesterol precursor in skin to become pre-vitamin D but does not induce a tan. Too much UVB can damage the skin. Natural sunlight is the best.

5. If you’re considering vitamin D supplements, then consider vitamin D3. Dosages vary depending on the physician: a daily dosage of 1000 IU to 5000 IU for three months is not uncommon. However, talk with your healthcare provider to see what is appropriate for you.

BTW, I’ve added a page explaining rheumatoid arthritis factors, more commonly called rheumatoid factors or RF for short.

Wishing you and your family a rapid healing journey,


Kathy Molnar-Kimber, Ph.D.

Private consultations are available.

Please note: the information on this website is a sharing of information and knowledge from the research and experience of Dr. Molnar-Kimber and her community. It is not intended to replace your one on one relationship with a qualified health care professional. It also is not intended to be medical advice. However, it is often observed that patients who take a major interest in their disease and learn as much as they can about their disease and potential treatments often improve faster than those who don’t. Dr. Molnar-Kimber encourages you to make your own health care decisions based upon your own research and discussions with your qualified health care professional.

Selected References

1. Raczkiewicz A, Kisiel B, Kulig M, Tlustochowicz W: Vitamin d status and its association with quality of life, physical activity, and disease activity in rheumatoid arthritis patients. Journal of clinical rheumatology 2015, 21(3):126-130.

2. Abourazzak FE, Talbi S, Aradoini N, Berrada K, Keita S, Hazry T: 25-Hydroxy vitamin D and its relationship with clinical and laboratory parameters in patients with rheumatoid arthritis. Clin Rheumatol 2015, 34(2):353-357.

3. Di Franco M, Barchetta I, Iannuccelli C, Gerardi MC, Frisenda S, Ceccarelli F, Valesini G, Cavallo MG: Hypovitaminosis D in recent onset rheumatoid arthritis is predictive of reduced response to treatment and increased disease activity: a 12 month follow-up study.

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