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Vitamin D is a steroid hormone that is best known for its central role in calcium and phosphate homeostasis1,2,3. Vitamin D deficiency [serum 25 OH-hydroxyvitamin D (25(OH)D) < 20 ng/ml] is complicated by rickets in children and osteomalacia in adults. Further, vitamin D deficiency and insufficiency [serum 25(OH)D < 30 ng/ml] contribute to osteoporosis and osteoporotic fractures through reduced bone mineral density and muscle mass, strength, and function, thus increasing the risk of falls. In persons 65 years of age or older, adequate vitamin D supplementation reduces the risk of hip and any nonvertebral fracture by 30% and 14%, respectively2. Impaired vitamin D status is prevalent worldwide, and vitamin D concentrations may have fallen further by 20% over the past 10 years3.The past 10 years have also witnessed a dramatically increased interest in vitamin D metabolism. This is because impaired vitamin D status was found to have — aside from its classical role in bone disease — numerous additional nonclassical adverse effects1,3,4,5. Thus, the vitamin D receptor (VDR), which is a member of the nuclear receptor superfamily, and key activating enzyme 25-OH-1α hydroxylase (CYP27B1), which converts 25(OH)D to its active metabolite 1,25 (OH)2D3, were shown to be present in multiple cell types. By its local synthesis and regulation of the transcription of as much as ∼ 3% of the human genome4, vitamin D can mediate its nonclassical effects through autocrine and paracrine mechanisms. Congruently, impaired vitamin D status has now been linked to a wide range of chronic conditions that include cardiovascular disease (CVD), diabetes, and autoimmune disorders. How relevant could these findings be to patients with rheumatoid arthritis (RA)?RA results in enhanced … Address correspondence to Professor Patrick H. Dessein, P.O. Box 1012, Melville 2109, Johannesburg, South Africa. E-mail: Dessein{at}telkomsa.net

Vitamin D Replacement Therapy: A Promising Adjunct in Cardiovascular Risk Management Among Patients with Rheumatoid Arthritis?