Vitamin d and arthritis

TUESDAY, March 8, 2016 (HealthDay News) — Vitamin D supplements didn’t relieve pain or slow the progression of knee osteoarthritis in a new study, even though the patients involved had low levels of the vitamin.

Osteoarthritis is a progressive disease, and currently no treatment is available that will stop the loss of cartilage. Eventually, many patients are headed for knee replacements, the Australian researchers said.

“These data suggest a lack of evidence to support vitamin D supplementation for slowing disease progression or structural change in knee osteoarthritis,” said lead researcher Dr. Changhai Ding, a professor at the University of Tasmania in Hobart.

The use of vitamin D supplements to reduce pain and slow the progression of knee osteoarthritis has been controversial in the past, with studies showing conflicting results, he said.

This new study put vitamin D supplements to the test by randomly assigning some osteoarthritis sufferers to receive supplements while others received a placebo. In the context of this type of definitive study, vitamin D failed to have any beneficial effect, Ding’s team found.

Knee osteoarthritis affects about 10 percent of men and 13 percent of women aged 60 and older, according to background information in the report. The study was published in the March 8 issue of the Journal of the American Medical Association.

The study findings did not come as a surprise to Dr. Neil Roth, an orthopedic surgeon at Lenox Hill Hospital in New York City.

“Osteoarthritis is a progressive disease and any medications patients take, orally or injected, won’t alter the disease,” he said. “The best we can do without a joint replacement is to modify some of the symptoms.”

These treatments include anti-inflammatory drugs, painkillers and cortisone injections, he said. These therapies do not stop the disease from getting worse and only relieve some of the symptoms, Roth said.

For the study, Ding and colleagues randomly assigned just over 400 patients with knee osteoarthritis and low vitamin D levels to monthly treatment with either 50,000 International Units of vitamin D a month or a placebo.

Arthritis and Vitamin D: What’s the Connection?

Vitamin D got its nickname, “the sunshine vitamin,” because sun exposure helps promote vitamin D production in the body. This essential nutrient is also found naturally in a few foods such as oily fish (mackerel, salmon) and is used to fortify milk, baby formula, cereal, and juice. But changing lifestyles and diets mean that many of us are lacking in vitamin D. In fact, it’s estimated that about 75 percent of American teens and adults don’t get enough vitamin D, and studies suggest that this may play a role in several chronic diseases, including arthritis.

Just what role does vitamin D play in arthritis and arthritis symptoms? “It’s hard to know at what level it’s working,” says Carolyn Dean, MD, ND, the Maui, Hawaii-based medical director for the Nutritional Magnesium Association and author of Future Health Now Encyclopedia. Vitamin D may affect arthritis pain by affecting the joints directly or by interacting with the immune system, she adds.

Arthritis and Vitamin D: What the Research Says

Research has found that vitamin D may play a significant role in joint health, and that low levels may increase the risk of rheumatologic conditions such as arthritis. Several studies have found low blood levels of vitamin D in patients with osteoarthritis of the hip and knee. In another study of more than 2,000 people, researchers found that vitamin D deficiency was strongly associated with disabling symptoms among those with rheumatoid arthritis. While it may be true that people with arthritis don’t get as much sun exposure — exposure to the sun helps promote vitamin D production in the body — the study authors adjusted for that and still found that being vitamin D deficient was linked to arthritis pain.

In the United States, studies have also suggested that women who live in northern states, and hence tend to get less daily sun exposure, may be at higher risk of developing rheumatoid arthritis compared with women living at more southern latitudes. In a recent study of data from the Nurses’ Health Study, researchers found women who lived in the northeastern United States had a significantly higher risk of rheumatoid arthritis.

Getting Enough Vitamin D

In addition to helping prevent arthritis, getting enough vitamin D may also lower the risk for other autoimmune diseases, cancer, heart disease, type 2 diabetes, bone fractures, depression, and even the flu.

If vitamin D has the potential to improve your arthritis symptoms and your overall health, you want to know that you’re getting enough.

Consider these strategies to keep your vitamin D levels optimal:

  • Spend some time in the sun. Dermatologists will tell you to slather on sunscreen any time you’re outside to avoid skin cancer — and rightfully so since skin cancer can be deadly. Nevertheless, sun exposure is a good way to build up your levels of vitamin D. Luckily, it takes just a few minutes of sun exposure for your body to use the sun’s rays to make vitamin D. Be sure to apply or reapply sunscreen after getting some brief exposure to sunshine each day.
  • Consider a daily supplement. In addition to soaking up some sun, it’s probably a good idea to take a vitamin D supplement to be sure you’re getting enough, especially if you live in northern states where the sun’s rays may not be strong enough for your body to make enough vitamin D in the winter. Doctors recommend taking 800 to 1,000 international units, or IU, of vitamin D a day. (Some multivitamins include 1,000 IU of vitamin D, so check the label.) If you buy the supplement separately from your multivitamin, be sure to choose vitamin D3, a natural form of vitamin D that lasts longer in your body, advises Dr. Dean.
  • Get tested. Symptoms of vitamin D deficiency include chronic pain, frequent infections, gastrointestinal problems, depression, and weak bones. If you think you may be deficient, or if you’re thinking about taking more than 1,000 IU of vitamin D a day, have your doctor test your blood levels, Dean suggests. Then you’ll be able to take a safe and effective dose.

Although vitamin D is found in some foods, it can be hard to get it from your diet, Dean says. Fatty fish such as salmon, tuna, and mackerel contain vitamin D, but they may also contain mercury and shouldn’t be eaten in large quantities. Foods that are fortified, such as milk, have the synthetic form of vitamin D and don’t offer as many long-term benefits, Dean adds.

Focus on getting a healthy amount of sun exposure and consider taking a supplement that contains vitamin D3 to help with arthritis symptoms.

Could vitamin D help prevent rheumatoid arthritis?

“Vitamin D may help prevent rheumatoid arthritis, suggests study,” is the headline in The Guardian. This is in reference to a UK-based laboratory study looking into whether vitamin D could be used to suppress inflammation in individuals with rheumatoid arthritis.

Rheumatoid arthritis is an autoimmune disease, which means the immune system mistakenly attacks the body’s own cells. In rheumatoid arthritis, the immune system targets the cells that line the joints, causing them to become swollen (inflamed), stiff and painful.

Previous laboratory research has suggested that vitamin D has anti-inflammatory effects, so the current researchers wanted to see if it could help inflammatory conditions such as rheumatoid arthritis.

They analysed samples of joint fluid from people with rheumatoid arthritis and found that vitamin D did not have the expected anti-inflammatory effect that it usually does in healthy joint fluid. This was because it had a limited impact on the immune system cells, so making these immune system cells responsive to vitamin D could offer a new way to prevent flare-ups of the disease.

It could be that regularly taking a vitamin D supplement may prevent rheumatoid arthritis developing in the first place, but this is pure speculation at the moment.

For now, regardless of possible effects on inflammation, it’s recommended that all adults take a daily supplement containing 10mcg of vitamin D during the autumn and winter months. Continuing to take it during the spring and summer may have limited benefits but should be entirely safe.

Where did the story come from?

The study was carried out by a team of researchers from University College London and several institutions in Birmingham. It was funded by the European Union, National Institutes of Health, Arthritis Research UK and the Royal Society Wolfson Research Merit Award.

The study was published in the peer-reviewed Journal of Autoimmunity on an open-access basis, so it can be viewed online for free.

The Guardian’s coverage was generally balanced. However, its headline could be interpreted as referring to a much more advanced stage of research than actually was the case. The study didn’t look at the effects of giving vitamin D supplements to people with rheumatoid arthritis – it only looked at levels of vitamin D and inflammatory cells in samples in a laboratory setting.

What kind of research was this?

This was a laboratory study aiming to investigate whether vitamin D could suppress inflammation in individuals with rheumatoid arthritis and whether this effect, if confirmed, may have potential in the prevention or treatment of inflammatory disorders.

Previous laboratory research has suggested that vitamin D may be able to reduce the immune response when necessary. However, this has only involved tests on blood samples from healthy individuals. The researchers of this study wanted to look at the effects of vitamin D in individuals with inflammatory disease.

Laboratory studies are useful as early-stage research for getting an indication of biological processes and how things may work in the body. However, many more stages would be needed to better understand the role of vitamin D in rheumatoid arthritis before getting to the point of conducting a randomised controlled trial (RCT) to see whether taking vitamin D supplements would actually improve symptoms in individuals with the condition.

What did the research involve?

The researchers took samples of joint synovial fluid from 15 individuals with rheumatoid arthritis aged between 40 and 85. Synovial fluid acts much like biological engine oil by helping to keep the joints lubricated.

They analysed the samples for levels of specific white blood cells (T helper cells) and inflammatory proteins involved in the type of immune response associated with rheumatoid arthritis.

To compare responses with healthy tissue, the researchers also looked at anonymised blood samples from age- and gender-matched donors from the National Blood Service in Birmingham, UK.

The researchers cultured (grew in the lab) specific subtypes of T helper cells – Th1 and Th17 cells – known to have a role in inflammatory conditions such as rheumatoid arthritis. They then looked at the effect of vitamin D on these cells.

What were the basic results?

The researchers found that vitamin D was better able to suppress the production of inflammatory proteins by Th17 cells in the healthy blood samples than it was in the rheumatoid arthritis samples.

Vitamin D had no effect on Th1 immune cells in either of the samples.

Looking for a possible explanation, they found that vitamin D may have a reduced anti-inflammatory effect in people with rheumatoid arthritis because, in general, vitamin D had a limited effect on a type of T helper cell known as memory T cells. People with rheumatoid arthritis are thought to have higher-than-average levels of memory T cells in their synovial fluid.

How did the researchers interpret the results?

The researchers suggested: “Restoration of 1,25(OH)2D3 responses in memory T cells may provide a new strategy for treatment of inflammatory diseases such as rheumatoid arthritis.”

However, because vitamin D was found to have a limited effect on the T cells from the site of inflammation, they cautioned: “Vitamin D supplementation is unlikely to be successful as treatment for established active rheumatoid arthritis patients.”

Conclusion

Previous research has suggested that vitamin D has anti-inflammatory effects, so this laboratory study investigated whether vitamin D could be used to suppress inflammation in individuals with rheumatoid arthritis, to prevent flare-ups of symptoms.

However, it found that adding vitamin D to joint fluid samples from people with rheumatoid arthritis had limited success in suppressing the inflammatory response compared with the effect it has on blood from healthy donors. It seems that the memory T cells in the joint fluid samples taken from people with rheumatoid arthritis are not responsive.

If it were possible to make these cells respond to vitamin D, then this could be a new avenue for treatment. But if anything, it seems more likely that vitamin D may have potential as a way to prevent inflammatory conditions like rheumatoid arthritis from developing in the first place.

While this is an interesting possibility, this early-stage study only looked at a very small sample of people. Further laboratory studies would be needed to better understand the role of vitamin D in inflammatory conditions before research could move on to trial vitamin D supplements in the prevention or treatment of these conditions.

For the moment, we know that vitamin D is essential to keep bones, teeth and muscles healthy. It can be created by the body from direct sunlight and can also be found in a few food sources such as:

  • oily fish
  • red meat
  • liver
  • egg yolks

In the spring and summer months, most people should be able to get all the vitamin D they need from natural sunlight exposure, but taking a daily supplement of 10mcg of vitamin D is recommended during the autumn and winter months. However, there should be no risk to your health if you also choose to take a 10mcg supplement during spring and summer.

It’s advised that breastfed babies up to 1 year old should be given an 8.5 to 10mcg supplement, while children from 1 to 4 years old should be given a 10mcg supplement.

Read more advice about vitamin D supplementation.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Vitamin D may help prevent rheumatoid arthritis, suggests study

The Guardian, 21 November 2017

Links to the science

Jeffrey LE, Henley P. Marium N, et al.

Decreased sensitivity to 1,25-dihydroxyvitamin D3 in T cells from the rheumatoid joint

Journal of Autoimmunity. Published online October 21 2017

6 Vitamins and Supplements for Inflammatory Arthritis That Doctors Approve

There’s something appealing about being able to help manage a chronic illness with so-called “natural” remedies like vitamins and minerals. That explains why there’s no shortage of natural remedies marketed to people with rheumatoid arthritis and other forms of inflammatory arthritis.

There is a shortage, however, of solid scientific evidence to support whether or not you should take certain supplements. Will they actually help improve arthritis symptoms? Could they interact with other medications you take? Or might they potentially have negative side effects of their own?

“Herbal supplements in particular concern me because they’re marketed using testimonials and not on any clinical data,” says William Davis, MD, the chair of rheumatology at Oschner Health System in New Orleans and a fellow of the American College of Physicians and the American College of Rheumatology. “As a physician, it’s my role to recommend treatments where there’s a higher understanding of risks and benefits.”

There are, however, certain vitamins and minerals that research shows can be an essential part of treatment for many patients with inflammatory arthritis. We asked Dr. Davis which ones you may need as part of your recommended treatment plan, as well as which natural remedies may show the most promise in helping with pain relief.

Supplements Backed by Science

1) Folic acid

Not everyone with rheumatoid arthritis needs to take folic acid, which is the synthetic form of folate, a type of B vitamin that is involved in such critical functions as cell division and the production of new red blood cells. But if your rheumatologist prescribes the disease-modifying drug methotrexate to treat your arthritis, they’ll most likely recommend you take folic acid supplements to prevent a folate deficiency.

“One of methotrexate’s most important mechanisms of action also inhibits folic acid metabolism, and that can lead to a folate deficiency,” Dr. Davis explains. It’s such a serious concern that prescribing methotrexate and folic acid supplements together “is pretty much standard of care,” he adds.

Fortunately, taking folic acid supplements can help mitigate some of the folate deficiency-induced side effects of methotrexate, which range from hair loss and mouth ulcers to more serious issues such as decreases in blood cell counts and elevated liver enzymes.

This may be why a 2013 research review conducted by The Cochrane Collaboration found that people who take folic acid supplements with methotrexate are significantly less likely to discontinue methotrexate treatment than those who didn’t take folic acid.

2) Calcium

Doctors and nutritionists generally prefer that people get their calcium from food rather than supplements, but there are exceptions. “If you have RA and you’re diagnosed with osteopenia or osteoporosis — or you’re already being treated for osteoporosis — your doctor may recommend you take calcium supplements,” says Dr. Davis.

People with inflammatory arthritis who are treated with glucocorticoids — steroids that are often used to stop arthritis flares — may also need to take a calcium supplement. These drugs suppress bone formation and promote resorption, which can lead to glucocorticoid-induced osteoporosis.

Fortunately, a research review published in the Cochrane Database of Systematic Reviews showed that taking both calcium and vitamin D helped prevent bone loss in people taking corticosteroids. Ask your doctor if calcium supplements are a good idea for you based on your health history, diet, and medication regimen.

3) Vitamin D

While studies suggest that many Americans may be deficient in D, the problem appears to be even more prevalent among people with rheumatoid arthritis, according to a study published in the journal Therapeutic Advances in Endocrinology and Metabolism.

Dr. Davis says it’s not understood why this association exists (one theory is that the inflammation of RA may decrease levels of vitamin D), but it is worrisome. “It’s an area of ongoing research,” he says. “We are concerned that people with RA tend to be low in D because it could be associated with poor bone health.”

While there are no strong, well-done studies that show that vitamin D supplementation helps protect the bones of people with rheumatoid arthritis, rheumatologists do sometimes recommend taking vitamin D. That’s because anyone with inflammatory arthritis is already at greater risk of osteoporosis. The disease itself appears to trigger bone loss, as does inactivity. And glucocorticoids, as noted above, can cause bone loss.

If you aren’t already taking vitamin D, should you start doing so? Not without talking to your rheumatologist first, Dr. Davis says. “Determining whether someone with arthritis needs vitamin D supplements is usually done on a case-by-case basis,” he explains. Your doctor will want to test your D levels and then make a dosage recommendation based on the results as well as factors such as your age and sex.

4) Fish oil

These pills, which contain anti-inflammatory omega-3 fatty acids, may help ease symptoms of RA. “This is one area where we have seen controlled studies that show that taking them results in lower measures and symptoms of inflammation in people with RA,” Dr. Davis says.

For example, a research review in the journal Pain revealed that fish oil supplement use was associated with less joint pain, shorter duration of morning stiffness, and a reduction in the number of painful and/or swollen joints.

Supplements That Show Promise

5) Turmeric

This trendy spice has been touted for its antioxidant compounds and anti-inflammatory properties. And there’s a chance it may just live up to the hype when it comes to easing pain from RA.

“It’s quite possible that there is some chemical component in turmeric that works like ibuprofen or an even stronger drug we have yet to identify,” Dr. Davis says.

Studies that demonstrate turmeric’s effectiveness in people with inflammatory arthritis are very small. However, a review of existing studies showed that they “do provide a compelling justification for use as a dietary adjunct to conventional therapy.”

While turmeric supplements are widely available, it’s best to talk to your rheumatologist before you try them. They can interact with some medications such as blood thinners and diabetes drugs, and the supplements may not be safe if you have certain health conditions such as diabetes, gallbladder disease, and bleeding disorders.

6) CBD (cannabidiol) oil

CBD oil has been a hot topic lately; many proponents claim that this component of the cannabis plant can treat everything from anxiety to inflammation. However, Dr. Davis says there’s not much data supporting its use in people with RA yet; the studies that do exist are small. But CBD oil does have some potential: A 2016 research review in the journal Arthritis Care & Research suggested that cannabinoid treatments could provide some pain relief and improve sleep in those with RA.

The concern is that CBD oil isn’t legal nationwide. If you’re thinking about trying it, talk to your rheumatologist first to discuss whether you can access it and if it would be safe for you use.

Keep Reading

  • 12 Daily Healthy Habits You Should Try if You Have Arthritis
  • Science-Backed Weight Loss Tips that May Help Arthritis Patients Slim Down
  • Please Don’t Say These 14 Things to Someone with RA

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