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Clin Exp Rheumatol. 2019 Sep 17. [Epub ahead of print]

Is cholecalciferol a potential disease modifying anti-rheumatic drug for the management of rheumatoid arthritis?

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Dept. Translational Med, Università del Piemonte Orientale UPO; Div. of Internal Medicine, Immuno-Rheumatology Unit, Ctre Translational Research on Autoimmune & Allergic Disease, Hosp. Maggiore della Carità, Interdisciplinary Res. Ctr. Autoimmune Dis, Novara, Italy.
Rheumatology and Clinical Immunology Unit and Department of Clinical and Experimental Sciences, Spedali Civili and University of Brescia, Italy.
IRCAD, Interdisciplinary Research Centre of Autoimmune Diseases, Novara, Italy; and Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Inst., Queen Mary Univ. of London, UK.
Department of Translational Medicine, Università del Piemonte Orientale UPO, Novara, and Emergency Medicine Department, "Maggiore della Carità" Hospital, Novara, Italy.
Department of Translational Medicine, Università del Piemonte Orientale UPO; and Division of Internal Medicine, Immuno-Rheumatology Unit, Center for Translational Research on Autoimmune and Allergic Disease, "Maggiore della Carità" Hosp., Novara, Italy.


Vitamin D is a pleiotropic molecule with a well-characterised immunomodulatory activity in vitro; however, its potential clinical application in autoimmune conditions has yet to be clarified. Several authors have investigated the use of vitamin D as a disease-modifying anti-rheumatic drug (DMARD) in rheumatoid arthritis (RA), obtaining divergent conclusions. This systematic review summarises and critically analyses the findings of papers assessing the impact of vitamin D supplementation on pain relief, disease activity, functional status and flare rate. We conclude that the correction of hypovitaminosis D may have a beneficial effect on pain perception; moreover, the achievement of an adequate plasma vitamin D concentration obtained with high-dose regimens might evoke immunomodulatory activities of vitamin D and favourably impact on disease control. Nevertheless, the current evidence is still not strong enough to support the use of cholecalciferol as a DMARD in RA, and further studies are required to clarify this issue.


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