Vitamin D3 Insufficiency and Its Correlation with Disease Severity and Diagnostic Biomarkers in Rheumatoid Arthritis : A Case-Control Study
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Date
2025-04
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Publisher
Indian Medical Association
Abstract
Background : This study aimed to identify Vitamin D3 insufficiency in patients with Rheumatoid Arthritis (RA) and investigate the correlation between Vitamin D3 and anti-cyclic Citrullinated Peptide (anti-CCP) antibodies and disease severity. The diagnostic value of Anti-CCP, RF, ESR, and hs-CRP was also evaluated. Methods: Selectra (Pro-XL) was used to estimate the lipid profile using commercially available kits. Anti-CCP and 25- (OH) Vitamin D (Vitamin D3) levels were measured using an immunoassay (ARCHITECT System, Abbott, Japan). The ESR was estimated using the Wintrobe’s tube method. RA factor and hs-CRP levels were measured using the immunoturbidity method. Disease activity/severity was estimated using the Clinical Disease Activity Index (CDAI) scoring. Results : The RA factor, hs-CRP and anti-CCP levels were significantly higher in patients than controls (p<0.0001), while Vitamin D3 levels were significantly lower (p<0.0001). A significant correlation was found between the RA factor and anti-CCP (r=0.678, p<0.0001), ESR and anti-CCP (r=0.469, p<0.0001) and a negative correlation between Vitamin D3 and anti-CCP (r=-0.224, p=0.046). Vitamin D3 levels were significantly correlated with the RA factor (r=-0.481, p=0.028). In patients with severe disease, Vitamin D3 level was associated with anti-CCP (?=0.409, p=0.018). The RA factor and anti-CCP demonstrated high specificity and sensitivity, with a PPV of 66% and 68% and NPV of 99.9% each. The AUC was significantly higher for anti-CCP (0.879, p<0.0001) and RA factor (0.813, p<0.0001) than for hs-CRP and ESR, indicating superior diagnostic performance. Conclusion : The study concludes that Vitamin D3 levels may determine the severity of RA and also suggests that the endorsed criteria should include the RA factor due to its diagnostic value equivalent to that of anti-CCP.
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Keywords
Vitamin D3, Anti-CCP Antibodies, Rheumatoid Factor, Rheumatoid Arthritis, CDAI Scoring.
Citation
Sharma M, Anand KV, Kumar A, Ram VS, Sharma P, Jawad K. Vitamin D3 Insufficiency and Its Correlation with Disease Severity and Diagnostic Biomarkers in Rheumatoid Arthritis : A Case-Control Study. Journal of The Indian Medical Association. 2025 Apr; 123(4): 55-61