Eficacia de la suplementación oral con vitamina d en la actividad de la artritis reumática. Revisión sistemática y metaanálisis
DOI:
https://doi.org/10.56048/MQR20225.9.1.2025.e180Palabras clave:
vitamina D; 25-hidroxi-vitamine D; calcifediol; colecalciferol; ergocalciferol; vitamin D supplementationResumen
El presente estudio aborda la eficacia de la suplementación con vitamina D en pacientes con artritis reumática (AR) al considerar su perfil farmacológico seguro y sus beneficios inmunoinflamatorios. El objetivo fue evaluar el impacto de la suplementación en la actividad clínica y el estado proinflamatorio de la enfermedad en pacientes mayores de 18 años diagnosticados con AR que utilizan los parámetros DAS-28, proteína C reactiva (PCR) y la escala de valoración analógica (EVA). Se realizó una búsqueda sistemática en bases de datos como PUBMED Advanced, SCOPUS, ClinicalKey y Ovid, desde 2017 hasta 2022 que incluyen ensayos clínicos controlados con suplementación oral de vitamina D3 (≥ 50.000 UI por al menos 6 semanas) en pacientes con AR diagnosticada según los criterios ACR/EULAR 2010 y ACR 1987. Se seleccionaron seis ensayos clínicos controlados aleatorizados con un total de 631 participantes. El metaanálisis reveló una disminución significativa en el puntaje DAS-28 (PDM= -0,80, IC 95%: -1,44; -0,15, p=0,01) y en la EVA (PDM= -0,79, IC 95%: -1,20; -0,39, p=0,0001) en el grupo de suplementación en comparación con el grupo control. Sin embargo, no se encontraron diferencias significativas en los niveles de PCR (PDM= -0,27, IC 95%: -0,73; 0,20, p=0,26). En conclusión, la vitamina D se presenta como una alternativa eficaz como terapia coadyuvante para mejorar algunos parámetros clínicos en la AR, recomendándose su uso basado en los niveles séricos de 25(OH) vitamina D de los pacientes.
Descargas
Métricas
Cited
DOI: 10.56048
Citas
Adami, G., Rossini, M., Bogliolo, L., Cantatore, F. P., Varenna, M., Malavolta, N., del Puente, A., Muratore, M., Orsolini, G., Gatti, D., & Viapiana, O. (2019). An exploratory study on the role of vitamin D supplementation in improving pain and disease activity in rheumatoid arthritis. Modern Rheumatology, 29(6), 1059–1062. https://doi.org/10.1080/14397595.2018.1532622
Aletaha, D., & Smolen, J. S. (2018). Diagnosis and Management of Rheumatoid Arthritis: A Review. JAMA, 320(13), 1360–1372. https://doi.org/10.1001/JAMA.2018.13103
American College of Reumatology. (2022). Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. 2022 American College of Rheumatology (ACR) . https://www.rheumatology.org/Portals/0/Files/Integrative-RA-Treatment-Guideline-Summary.pdf
Aryaeian, N., Hadidi, M., Mahmoudi, M., Asgari, M., Hezaveh, Z. S., & Sadehi, S. K. (2021). The effect of black barberry hydroalcoholic extract on immune mediators in patients with active rheumatoid arthritis: A randomized, double-blind, controlled clinical trial. Phytotherapy Research : PTR, 35(2), 1062–1068. https://doi.org/10.1002/PTR.6874
Aryaeian, N., Shahram, F., Mahmoudi, M., Tavakoli, H., Yousefi, B., & Arablou, T. (2019). The effect of ginger supplementation on some immunity and inflammation intermediate genes expression in patients with active Rheumatoid Arthritis. Gene, 698, 179–185. https://doi.org/10.1016/J.GENE.2019.01.048
Aslam, M. M., John, P., Bhatti, A., Jahangir, S., & Kamboh, M. I. (2019). Vitamin D as a Principal Factor in Mediating Rheumatoid Arthritis-Derived Immune Response. BioMed Research International, 2019. https://doi.org/10.1155/2019/3494937
Bagheri-Hosseinabadi, Z., Imani, D., Yousefi, H., & Abbasifard, M. (2020). Vitamin D receptor (VDR) gene polymorphism and risk of rheumatoid arthritis (RA): systematic review and meta-analysis. Clinical Rheumatology, 39(12), 3555–3569. https://doi.org/10.1007/S10067-020-05143-Y
Balsa, A. (2011). Definiendo la remisión en la artritis reumatoide: nuevos criterios de la ACR/EULAR. Reumatología Clínica, 6(SUPPL. 3), 12–15. https://doi.org/10.1016/J.REUMA.2010.10.006
Bellan, M., Sainaghi, P. P., & Pirisi, M. (2017). Role of Vitamin D in Rheumatoid Arthritis. Advances in Experimental Medicine and Biology, 996, 155–168. https://doi.org/10.1007/978-3-319-56017-5_13
Buondonno, I., Rovera, G., Sassi, F., Rigoni, M. M., Lomater, C., Parisi, S., Pellerito, R., Carlo Isaia, G., & D’Amelio, P. (2017). Vitamin D and immunomodulation in early rheumatoid arthritis: A randomized double-blind placebo-controlled study. PLoS ONE, 12(6). https://doi.org/10.1371/JOURNAL.PONE.0178463
Cannarella, L. A. T., Mari, N. L., Alcântara, C. C., Iryioda, T. M. V., Costa, N. T., Oliveira, S. R., Lozovoy, M. A. B., Reiche, E. M. V., Dichi, I., & Simão, A. N. C. (2021). Mixture of probiotics reduces inflammatory biomarkers and improves the oxidative/nitrosative profile in people with rheumatoid arthritis. Nutrition (Burbank, Los Angeles County, Calif.), 89. https://doi.org/10.1016/J.NUT.2021.111282
Caraba, A., Crişan, V., Romoşan, I., Mozoş, I., & Murariu, M. (2017). Vitamin D Status, Disease Activity, and Endothelial Dysfunction in Early Rheumatoid Arthritis Patients. Disease Markers, 2017. https://doi.org/10.1155/2017/5241012
England BR, Smith BJ, Baker NA, et al. 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis. Arthritis Rheumatol. 2023;75(8):1299-1311. doi:10.1002/art.42507
Franco, A. S., Freitas, T. Q., Bernardo, W. M., & Pereira, R. M. R. (2017). Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis. Medicine, 96(23). https://doi.org/10.1097/MD.0000000000007024
Garcia, S., Fernandes, B. M., Pinheiro, F. O., Rato, M., Fonseca, D., Martins, A., Oliveira, D. S., Martins, F. R., Terroso, G., Bernardes, M., & Costa, L. (2021). POS0100 VITAMIN D LEVEL IN RHEUMATOID ARTHRITIS PATIENTS STARTING A BIOLOGIC DISEASE-MODIFYING DRUG AND ITS CORRELATION WITH DISEASE ACTIVITY AND RESPONSE TO TREATMENT. Annals of the Rheumatic Diseases, 80(Suppl 1), 260–260. https://doi.org/10.1136/ANNRHEUMDIS-2021-EULAR.1172
Giannini, D., Antonucci, M., Petrelli, F., Bilia, S., Alunno, A., & Puxeddu, I. (2020). One year in review 2020: Pathogenesis of rheumatoid arthritis. Clinical and Experimental Rheumatology, 38(3), 387–397. https://www.clinexprheumatol.org/abstract.asp?a=15504
Gkiouras, K., Grammatikopoulou, M. G., Myrogiannis, I., Papamitsou, T., Rigopoulou, E. I., Sakkas, L. I., & Bogdanos, D. P. (2022). Efficacy of n-3 fatty acid supplementation on rheumatoid arthritis’ disease activity indicators: a systematic review and meta-analysis of randomized placebo-controlled trials. Critical Reviews in Food Science and Nutrition, 1–15. https://doi.org/10.1080/10408398.2022.2104210
Global Burden of Diseases. (2019). VizHub - GBD Compare, Rheumatoid Arthritis Statistics DALYs and YLDs. BGD Compare. https://vizhub.healthdata.org/gbd-compare/
Guan, Y., Hao, Y., Guan, Y., Bu, H., & Wang, H. (2020). The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis. Frontiers in Medicine, 7. https://doi.org/10.3389/FMED.2020.596007
Gwinnutt, J. M., Verstappen, S. M., & Humphreys, J. H. (2020). The impact of lifestyle behaviours, physical activity and smoking on morbidity and mortality in patients with rheumatoid arthritis. Best Practice & Research. Clinical Rheumatology, 34(2). https://doi.org/10.1016/J.BERH.2020.101562
Haefeli, M., & Elfering, A. (2006). Pain assessment. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 15 Suppl 1(Suppl 1). https://doi.org/10.1007/S00586-005-1044-X
Hahn, J., Cook, N. R., Alexander, E. K., Friedman, S., Walter, J., Bubes, V., Kotler, G., Lee, I. M., Manson, J. A. E., & Costenbader, K. H. (2022). Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ, 376. https://doi.org/10.1136/BMJ-2021-066452
Hamidi, Z., Aryaeian, N., Abolghasemi, J., Shirani, F., Hadidi, M., Fallah, S., & Moradi, N. (2020). The effect of saffron supplement on clinical outcomes and metabolic profiles in patients with active rheumatoid arthritis: A randomized, double-blind, placebo-controlled clinical trial. Phytotherapy Research : PTR, 34(7), 1650–1658. https://doi.org/10.1002/PTR.6633
Hansen, K. E., Bartels, C. M., Gangnon, R. E., Jones, A. N., & Gogineni, J. (2014). An Evaluation of High-Dose Vitamin D for Rheumatoid Arthritis. Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases, 20(2), 112. https://doi.org/10.1097/RHU.0000000000000072
Harrison, S. R., Li, D., Jeffery, L. E., Raza, K., & Hewison, M. (2020). Vitamin D, Autoimmune Disease and Rheumatoid Arthritis. Calcified Tissue International, 106(1), 58–75. https://doi.org/10.1007/S00223-019-00577-2
Hartling, L., Hamm, M., Milne, A., Vandermeer, B., Santaguida, P. L., Ansari, M., Tsertsvadze, A., Hempel, S., Shekelle, P., & Dryden, D. M. (2012). Guidelines for Risk of Bias Assessments. https://www.ncbi.nlm.nih.gov/books/NBK92290/
Hazlewood, G. S., Pardo Pardo, J., Barnabe, C., Schieir, O., Barber, C. E. H., Proulx, L., Richards, D. P., Tugwell, P., Bansback, N., Akhavan, P., Bombardier, C., Bykerk, V., Jamal, S., Khraishi, M., Taylor-Gjevre, R., Thorne, J. C., Agarwal, A., & Pope, J. E. (2022). Canadian Rheumatology Association living guidelines for the pharmacological management of rheumatoid arthritis with disease-modifying anti-rheumatic drugs. The Journal of Rheumatology, jrheum.220209. https://doi.org/10.3899/JRHEUM.220209
Herly, M., Stengaard-Pedersen, K., Vestergaard, P., Østergaard, M., Junker, P., Hetland, M. L., Hørslev-Petersen, K., & Ellingsen, T. (2018). The D-vitamin metabolite 1,25(OH)2 D in serum is associated with disease activity and Anti-Citrullinated Protein Antibodies in active and treatment naïve, early Rheumatoid Arthritis Patients. Scandinavian Journal of Immunology, 88(3). https://doi.org/10.1111/SJI.12704
Higgins, J., & Thomas, J. (2022). Cochrane Handbook for Systematic Reviews of Interventions | Cochrane Training. Cochrane Training. Version 6.3. https://training.cochrane.org/handbook/current
Holick, M. F., Binkley, N. C., Bischoff-Ferrari, H. A., Gordon, C. M., Hanley, D. A., Heaney, R. P., Murad, M. H., & Weaver, C. M. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology and Metabolism, 96(7), 1911–1930. https://doi.org/10.1210/JC.2011-0385
Ilchovska, D. (Daisy), & Barrow, D. M. (2021). An Overview of the NF-kB mechanism of pathophysiology in rheumatoid arthritis, investigation of the NF-kB ligand RANKL and related nutritional interventions. Autoimmunity Reviews, 20(2). https://doi.org/10.1016/J.AUTREV.2020.102741
Ishikawa, L. L. W., Colavite, P. M., Fraga-Silva, T. F. de C., Mimura, L. A. N., França, T. G. D., Zorzella-Pezavento, S. F. G., Chiuso-Minicucci, F., Marcolino, L. D., Penitenti, M., Ikoma, M. R. V., & Sartori, A. (2017). Vitamin D Deficiency and Rheumatoid Arthritis. Clinical Reviews in Allergy & Immunology, 52(3), 373–388. https://doi.org/10.1007/S12016-016-8577-0
Ito, H., Nishida, K., Kojima, T., Matsushita, I., Kojima, M., Hirata, S., Kaneko, Y., Kishimoto, M., Kohno, M., Mori, M., Morinobu, A., Murashima, A., Seto, Y., Sugihara, T., Tanaka, E., Nakayama, T., Yamanaka, H., Kawahito, Y., & Harigai, M. (2022). Non-Drug and Surgical Treatment Algorithm and Recommendations for the 2020 Update of the Japan College of Rheumatology Clinical Practice Guidelines for the Management of Rheumatoid Arthritis - Secondary Publication. Modern Rheumatology. https://doi.org/10.1093/MR/ROAC019
Karimi, A., Azar, P. S., Kadkhodayi, M., Tandorost, A., Vajdi, M., Shoorei, H., & Farhangi, M. A. (2022). A comprehensive insight into effects of resveratrol on molecular mechanism in rheumatoid arthritis: A literature systematic review. International Journal of Rheumatic Diseases, 25(8), 827–843. https://doi.org/10.1111/1756-185X.14356
Khoja, S. O., El-Miedany, Y., Iyer, A. P., Bahlas, S. M., Balamash, K. S., & Elshal, M. F. (2018). Associations of Vitamin D Levels and Vitamin D Receptor Genotypes with Patient-Reported Outcome/Disease Activity in Patients with Rheumatoid Arthritis. Clinical Laboratory, 64(1), 51–58. https://doi.org/10.7754/CLIN.LAB.2017.170610
Kou, H., Qing, Z., Guo, H., Zhang, R., & Ma, J. (2022). Effect of vitamin E supplementation in rheumatoid arthritis: a systematic review and meta-analysis. European Journal of Clinical Nutrition. https://doi.org/10.1038/S41430-022-01148-9
Letarouilly, J. G., Sanchez, P., Nguyen, Y., Sigaux, J., Czernichow, S., Flipo, R. M., Sellam, J., & Daïen, C. (2020). Efficacy of Spice Supplementation in Rheumatoid Arthritis: A Systematic Literature Review. Nutrients, 12(12), 1–12. https://doi.org/10.3390/NU12123800
Li, C., Yin, S., Yin, H., Cao, L., Zhang, T., & Wang, Y. (2018). Efficacy and Safety of 22-Oxa-Calcitriol in Patients with Rheumatoid Arthritis: A Phase II Trial. Medical Science Monitor : International Medical Journal of Experimental and Clinical Research, 24, 9127–9135. https://doi.org/10.12659/MSM.911628
Liao, C. de, Chen, H. C., Huang, S. W., & Liou, T. H. (2022). Exercise therapy for sarcopenia in rheumatoid arthritis: A meta-analysis and meta-regression of randomized controlled trials. Clinical Rehabilitation, 36(2), 145–157. https://doi.org/10.1177/02692155211035539
Lin, J., Liu, J., Davies, M. L., & Chen, W. (2016). Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis. PLOS ONE, 11(1), e0146351. https://doi.org/10.1371/JOURNAL.PONE.0146351
Lin, Y. J., Anzaghe, M., & Schülke, S. (2020). Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis. Cells, 9(4). https://doi.org/10.3390/CELLS9040880
Liu, L., Liu, S., Wang, C., Guan, W., Zhang, Y., Hu, W., Zhang, L., He, Y., Lu, J., Li, T., Liu, X., Xuan, Y., & Wang, P. (2019). Folate Supplementation for Methotrexate Therapy in Patients With Rheumatoid Arthritis: A Systematic Review. Journal of Clinical Rheumatology : Practical Reports on Rheumatic & Musculoskeletal Diseases, 25(5), 197–202. https://doi.org/10.1097/RHU.0000000000000810
Luqmani, R., Hennell, S., Estrach, C., Basher, D., Birrell, F., Bosworth, A., Burke, F., Callaghan, C., Candal-Couto, J., Fokke, C., Goodson, N., Homer, D., Jackman, J., Jeffreson, P., Oliver, S., Reed, M., Sanz, L., Stableford, Z., Taylor, P., … Wilkinson, M. (2009). British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of rheumatoid arthritis (after the first 2 years). Rheumatology (Oxford, England), 48(4), 436–439. https://doi.org/10.1093/RHEUMATOLOGY/KEN450A
Mateen, S., Moin, S., Shahzad, S., & Khan, A. Q. (2017). Level of inflammatory cytokines in rheumatoid arthritis patients: Correlation with 25-hydroxy vitamin D and reactive oxygen species. PLOS ONE, 12(6), e0178879. https://doi.org/10.1371/JOURNAL.PONE.0178879
McInnes, I. B., & Schett, G. (2017). Pathogenetic insights from the treatment of rheumatoid arthritis. Lancet (London, England), 389(10086), 2328–2337. https://doi.org/10.1016/S0140-6736(17)31472-1
Publicado
Cómo citar
Número
Sección
Categorías
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
®
Los autores se comprometen a respetar la información académica de otros autores, y a ceder los derechos de autor a la Revista MQRInvestigar, para que el artículo pueda ser editado, publicado y distribuido. El contenido de los artículos científicos y de las publicaciones que aparecen en la revista es responsabilidad exclusiva de sus autores. La distribución de los artículos publicados se realiza bajo una licencia 
