REVIEW ARTICLE


Vitamin D and Spondyloarthritis: Review of the Literature



Chiara Crotti1, Andrea Becciolini2, Martina Biggioggero1, Ennio Giulio Favalli2, *
1 Department of Clinical Sciences and Health Community, Division of Rheumatology, University of Milan, Gaetano Pini Institute, Milan, Italy
2 Department of Rheumatology, Gaetano Pini Institute, Milan, Italy


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© 2018 Crotti et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Rheumatology, Gaetano Pini Institute, Milan, Via Gaetano Pini, 9, 20122 Milan - Italy, Tel: +39 0258296421, Mobile: +39 3289659778, Fax: +39 0258296315; E-mail: enniofavalli@me.com


Abstract

Background:

Spondyloarthritides (SpAs) encompass heterogeneous diseases sharing similar genetic background, pathogenic mechanisms, and phenotypic features. Vitamin D is essential for calcium metabolism and skeletal homeostasis. Some recent evidences reported supplemental functions of vitamin D, such as modulation of inflammatory reactions.

Objective:

To analyze published data about a possible association between vitamin D and SpAs.

Results:

Vitamin D could play a role in immune reactions, influencing both immune and adaptive response. Vitamin D deficiency is more frequent in SpAs than in general population: an active and more severe disease infers patients’ mobility and reduces sunlight exposure. Quiescent inflammatory bowel disease, frequently associated with SpAs, could worsen vitamin D deficiency. All the parameters related to UVB exposure are the most important determinants for vitamin D status and need to be considered evaluating the vitamin D levels in SpAs.

Apart from musculoskeletal problems, patients affected by SpAs frequently suffer from other comorbidities, especially cardiovascular diseases and osteoporosis, and vitamin D status could have a relevance in this field. Bone is involved in SpAs with a dualistic role, coexisting trabecular bone resorption and new bone formation.

It seems rational to monitor vitamin D levels in SpA subjects and to target it to global health threshold.

Conclusion:

Literature data were not completely in agreement about a possible relation between poor vitamin D status and onset or worse disease course of SpAs. In fact, these results come from cross-sectional studies, which affect our ability to infer causality. Therefore, large, randomized controlled trials are needed.

Keywords: Vitamin D, Spondyloarthritis, Reactive arthritis, Ankylosing spondylitis, Psoriatc arthritis, Enteropathic arthritis.