Vitamin D status and bone mineral density in patients with juvenile rheumatoid arthritis




juvenile rheumatoid arthritis, bone mineral density, calcidiol


Background. Monitoring bone mineral density (BMD) in patients with juvenile rheumatoid arthritis (JRA) with additional assessment of calcidiol (25(OH)D) serum level is an indicator of catabolism status and a criterion of successful therapy. Our objective was to evaluate the bone densitometry data and calcidiol level in patients with JRA in order to determine the osteopenic syndrome and the advisability of prescribing additional doses of vitamin D. Materials and methods. The calcidiol level and BMD were assessed in 65 patients with JRA. The data were processed using Pearson’s chi-squared test and Spearman’s rank correlation coefficient. Results. There was a violation of vitamin D level in 92 % of patients with JRA. 60 % of patients were diagnosed with secondary osteopenic syndrome (Z-score ≤ –2 SD) using the dual-energy X-ray absorptiometry. It was revealed that persons, who receive biological disease-modifying antirheumatic drugs as a part of integrated treatment, demonstrate significantly better results (р < 0.01) according to BMD assessment data. The strong negative association (Spearman’s coefficient was –0.72) was observed between BMD and the level of disease activity. A direct moderate correlation was found between BMD and calcidiol level (Spearman’s correlation coefficient is 0.39). Conclusions. We assume that it would be appropriate to evaluate the calcidiol level and BMD score in the management of JRA patients. 68 % of persons with JRA, who receive biological disease-modifying antirheumatic drugs as a part of standard therapy, have normal BMD.


Manners PJ, Bower C. Worldwide prevalence of juvenile arthritis - why does it vary so much? J Rheumatol. 2002 Jul;29(7):1520-30.

Janicka-Szczepaniak M, Orczyk K, Szymbor K, Chlebna-Sokół D, Smolewska E. Is it possible to predict a risk of osteoporosis in patients with juvenile idiopathic arthritis? A study of serum levels of bone turnover markers. Acta Biochim Pol. 2018;65(2):297-302. doi: 10.18388/abp.2017_2561.

Lurati A, Cimaz R, Gattinara M, et al. Skeletal mineralization in a prepubertal female population affected by juvenile idiopathic arthritis. Reumatismo. 2008 Jul-Sep;60(3):224-9.

Weinstein RS, Jilka RL, Parfitt AM, Manolagas SC. Inhibition of osteoblastogenesis and promotion of apoptosis of osteoblasts and osteocytes by glucocorticoids. Potential mechanisms of their deleterious effects on bone. J Clin Invest. 1998 Jul 15;102(2):274-82. doi: 10.1172/JCI2799.

Binkovitz LA, Henwood MJ. Pediatric DXA: technique and interpretation. Pediatr Radiol. 2007 Jan;37(1):21-31. doi: 10.1007/s00247-006-0153-y.

Gordon CM, Leonard MB, Zemel BS; International Society for Clinical Densitometry. 2013 Pediatric Position Development Confer­ence: executive summary and reflections. J Clin Densitom. 2014 Apr-Jun;17(2):219-24. doi: 10.1016/j.jocd.2014.01.007.

Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y. Vitamin D in systemic and organ-specific autoimmune diseases. Clin Rev Allergy Immunol. 2013 Oct;45(2):256-66. doi: 10.1007/s12016-012-8342-y.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385.

Sabbagh Z, Markland J, Vatanparast H. Vitamin D status is associated with disease activity among rheumatology outpatients. Nutrients. 2013 Jun 26;5(7):2268-75. doi: 10.3390/nu5072268.

Finch SL, Rosenberg AM, Vatanparast H. Vitamin D and juvenile idiopathic arthritis. Pediatr Rheumatol Online J. 2018 May 16;16(1):34. doi: 10.1186/s12969-018-0250-0.

Bouaddi I, Rostom S, El Badri D, et al. Vitamin D concentrations and disease activity in Moroccan children with juvenile idiopathic arthritis. BMC Musculoskelet Disord. 2014 Apr 1;15:115. doi: 10.1186/1471-2474-15-115.

Stagi S, Bertini F, Cavalli L, Matucci-Cerinic M, Brandi ML, Falcini F. Determinants of vitamin D levels in children, adolescents, and young adults with juvenile idiopathic arthritis. J Rheumatol. 2014 Sep;41(9):1884-92. doi: 10.3899/jrheum.131421.

de Sousa Studart SA, Leite AC, Marinho AL, et al. Vitamin D levels in juvenile idiopathic arthritis from an equatorial region. Rheumatol Int. 2015 Oct;35(10):1717-23. doi: 10.1007/s00296-015-3287-0.

Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D. Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum. 2007 Jul;56(7):2143-9. doi: 10.1002/art.22722.

El-Hajj Fuleihan G, Nabulsi M, Tamim H, et al. Effect of vitamin D replacement on musculoskeletal parameters in school children: a randomized controlled trial. J Clin Endocrinol Metab. 2006 Feb;91(2):405-12. doi: 10.1210/jc.2005-1436.

Viljakainen HT1, Natri AM, Kärkkäinen M, et al. A positive dose-response effect of vitamin D supplementation on site-specific bone mineral augmentation in adolescent girls: a double-blinded randomized placebo-controlled 1-year intervention. J Bone Miner Res. 2006 Jun;21(6):836-44.

Gómez-Vaquero C, Fiter J, Enjuanes A, Nogués X, Díez-Pérez A, Nolla JM. Influence of the Bsml polymorphism of the vitamin D receptor gene on rheumatoid arthritis clinical activity. J Rheumatol. 2007 Sep;34(9):1823-6.

Povoroznyuk VV, Sinenky OV. Influence of Vitamin D Deficiency on Rheumatoid Arthritis Course. Bolʹ, sustavy, pozvonočnik. 2016;(23):15-21. doi: 10.22141/2224-1507.3.23.2016.85001. (in Ukrainian).

Ross AC, Taylor CL, Yaktine AL, et al., editors. Dietary Reference Intakes for Calcium and Vitamin D. Washington (DC): National Academies Press (US); 2011. 1132p. doi: 10.17226/13050.

Heaney RP, Davies KM, Chen TC, Holick MF, Barger-Lux MJ. Human serum 25-hydroxycholecalciferol response to extended oral dosing with cholecalciferol. Am J Clin Nutr. 2003 Jan;77(1):204-10. DOI: 10.1093/ajcn/77.1.204.





Clinical Pediatrics