When I first got diagnosed with rheumatoid arthritis, my Vitamin D levels were extremely low. Living in New England this didn't come as a surprise. I picked up a Vitamin D supplement at Whole Foods with two ingredients: Vitamin D and peppermint. I started by taking 10,000 IU and have since decreased to 5,000 IU. After taking it for a couple months, I learned the importance of Vitamin D and autoimmunity. This has quickly turned into one of my forever supplements.

Vitamin D & RA Statistics

  • Vitamin D deficiency is highly prevalent in people with RA2
  • Prevalence of RA decreases in individuals with high intake of Vitamin D
  • Deficiency may be associated with disease activity
  • Low Vitamin D level in RA may lead to secondary osteoporosis
  • People with RA and depression have significantly lower Vitamin D levels than people with RA and without depression
  • Low Vitamin D levels have increased neuropathic pain1

Vitamin D Affects on RA

Vitamin D is a hormone produced when the skin is exposed to sunlight or absorbed through the foods we eat. It regulates 5% of the human genome and directly or indirectly regulates behavior of more than 36 different cell types1. Most importantly Vitamin D regulates the immune system, and deficiencies can even induce autoimmune diseases, including RA.

Liver and kidney enzymes convert Vitamin D to its active form, which goes on to support many functions, including regulating the immune system. It does this through three key pathways that are pertinent to RA. First, it maintains a balance of different types of immune cells, called T cells, to suppress autoimmune response1. Secondly, Vitamin D regulates cytokines, which are communication molecules within the immune system. One particular cytokine found to be elevated in people with RA is TNF. Studies have found that as Vitamin D increases, TNF decreases, and vice versa. Lastly, Estrogen boosts immune activity in joint tissue of people with RA, however, Vitamin D suppresses estrogen activity, thus controlling immune response3.

Vitamin D is heavily correlated with RA disease activity and anti-CCP level1. As Vitamin D decreases both disease activity and anti-ccp increases5. And vice-versa, as Vitamin D increases disease activity and anti-ccp decreases.

Importantly, Vitamin D helps regulate bone mineralization by stimulating calcium and phosphate absorption in the gut and bone cell differentiation. Bone mineralization is a delicate and dynamic process to form a fibrous matrix of collagen and minerals, including calcium and phosphate, within the bone. This fibrous matrix gives bone rigidity and structure to support our bodies. It's a process that constantly takes place throughout our lives.

Corticosteroids, such as prednisone, impairs vitamin D metabolism and reduces calcium absorption. This disrupts bone mineralization, which causes weak, brittle bones. Because of this, Osteoporosis is a secondary side effect to long-term prednisone use in people with RA4.

Should I Take a Vitamin D Supplement?

If you have RA, you may consider getting your Vitamin D levels tested and supplement with a Vitamin D3 as needed. Humans obtain Vitamin D in two forms: vitamin D2 and vitamin D3. Vitamin D3 is the main form we use. You may also want to consider a supplement with limited additives.

In addition, we should look to eat Vitamin D rich foods, which include fatty fish (salmon and tuna), fish liver oils, and small amounts in beef liver, cheese, and egg yolks.

Sun exposure is another crucial way of getting Vitamin D and only a small amount is needed. 5 to 30 minutes between 10 a.m. and 3 p.m. at least twice a week on the face arms legs or back without sunscreen raises Vitamin D to sufficient levels4.

Vitamin D can be used to prevent onset of autoimmune diseases. If you have a family history of autoimmune diseases, such as lupus or rheumatoid arthritis, it may be beneficial to consider taking a Vitamin D supplement to prevent activation and diagnosis.

References:

  1. Aslam, M., et al. (2019). Vitamin D as a principal factor in mediating rheumatoid arthritis-derived immune response. BioMed Research International.
  2. Kostoglou-Athanassiou, I. et al. (2012). Vitamin D and Rheumatoid Arthritis. Endocrinology and Metabolism. 3(6): 181-187.
  3. Harrison, S. R., Li S., Jaffrey, L. E., Raza, K., Hewison, M. (2019). Vitamin D, Autoimmune Disease and Rheumatoid Arthritis. Calcified Tissue International.
  4. Vitamin D. (N.D.) National Institute of Health.
  5. Wang, Y., et al. (2016). Serum Vitamin D Level is Inversely Associated With Anti-Cyclic Citrullinated Peptide Antibody Level and Disease Activity in Rheumatoid Arthritis Patients. Archives of Rheumatology. 31(1):64-70.