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EULAR 2017 | Daily Highlights
MAINTAINING SUFFICIENT SERUM VITAMIN D LEVELS OVER TWO YEARS IS ASSOCIATED WITH IMPROVED KNEE STRUCTURAL AND SYMPTOMATIC OUTCOMES IN PEOPLE WITH KNEE OSTEOARTHRITIS: A POST HOC ANALYSIS OF THE VIDEO TRIALAbstract: SAT0493
Authors: S. Zheng1,*, X. Jin1, F. Cicuttini2, X. Wang1, Z. Zhu1, A. Wluka3, W. Han1, T. Winzenberg1, B. E. Antony1, D. Aitken1, L. Blizzard 1, G. Jones1, C. Ding1
1Menzies Institute for Medical Research, University of Tasmania, Hobart, 2Department of Epidemiology and Preventive Medicine, Monash University, 3Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
Osteoarthritis causes joint pain, stiffness, and reduced function, leading to disability. CNTX-4975, a highly purified, synthetic trans-capsaicin, targets the transient receptor potential vanilloid 1, producing analgesia via reversible deactivation of end terminals of primary afferent pain fibers within the joint and capsule.
To describe whether maintaining sufficient serum vitamin D levels in people with knee osteoarthritis (OA) and baseline vitamin D insufficiency has an association with change in knee structures and symptoms over two years.
Participants (n= 413, age 63.2; 50% females) with symptomatic knee OA and vitamin D insufficiency were enrolled in a clinical trial. 340 participants (82.3%) completed the study with 25-hydroxyvitamin D [25(OH)D] measurements at month 0, 3 and 24. Participants were classified as consistently insufficient (serum 25(OH)D?50nmol/l at month 3 and 24, n=45), fluctuating (25(OH)D>50nmol/l at either point, n=68) and consistently sufficient (25(OH)D>50nmol/l at month 3 and 24, n=226) vitamin D groups. Knee cartilage volume, cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis volume were assessed using MRI at baseline and month 24. Knee symptoms were assessed at baseline, month 3, 6 12 and 24 using Western Ontario and McMaster Universities Arthritis Index (WOMAC).
The consistently sufficient group had significantly less loss of tibial cartilage volume (?: 2.1%, 95 CI%: 0.3%, 3.9%), less increase in effusion-synovitis volume (?: -2.5ml, 95 CI%: -4.7, -0.2) and less loss of WOMAC physical function (?: -94.2, 95% CI: -183.8, -4.5) compared to the consistently insufficient group in multivariable analyses. In contrast, there were no significant differences in these outcomes between the fluctuating and consistently insufficient groups. Changes in tibiofemoral cartilage defects, BMLs and knee pain were similar between groups.
Table 1 Associations between maintaining sufficient 25-(OH)D levels and changes in cartilage volume and effusion -volume over 24 months in patients with knee osteoarthritis
Adjusted age, sex and BMI and change in season of blood sampling;
This post hoc analysis suggests beneficial effects of maintaining vitamin D sufficiency on cartilage loss, effusion-synovitis and physical function in people with symptomatic knee OA.
1. Cao, Y., et al., Vitamin D supplementation in the management of knee osteoarthritis: study protocol for a randomized controlled trial. Trials, 2012. 13: p. 131.
2. Jin, X., et al., Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients With Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. JAMA, 2016. 315(10): p. 1005-13.
We specially thank the participants who made this study possible, and we gratefully acknowledge the role of Vitamin D Effect on Osteoarthritis Study staff and volunteers in collecting the data. We thank the research assistants Jodi Barling, Kay Nguo, Judy Hankin and Alice Noone who were involved in the coordination of this study?
Disclosure of Interest:
In the original VIDEO trial: a 3-year , double-blind, randomized, placebo-controlled trial (Arden et al. Osteoarthritis Cartilage;24(11):1858-1866), Vitamin D supplementation with 800 IU Cholecalciferol did not slow the rate of joint space narrowing or led to reduced pain, stiffness or functional loss over 3 years.In a post hoc analysis of this trial 340 participants in the original study population with 25 OH-Vitamin D level measurements at 0, 3 and 24 months were classified in three groups: Those with consistently sufficient 25-OH Vitamin D levels (>50 nmol/l, n=226), those with fluctuating levels (>50 nmol/l at either point, n=68) and those with consistently insufficient levels (< 50 nmol/l at 3 and 24 months, n=45). The consistently sufficient group had significant less loss of tibial cartilage volume, less increase in effusion-synovitis volume and less loss of WOMAC physical function. In contrast there were no significant differences in these outcomes between the fluctuating and consistently insufficient group. This post hoc analysis implicates that sustained sufficient Vitamin D levels decelerate the progression of knee osteoarthritis compared to Vitamin D deficient individuals.
Dr. Thomas Langenegger