RA and Pain: Vitamin D Deficiency Masquerading as RA Disease Activity

Nobody would argue that rheumatoid arthritis is associated with pain. In fact, pain, tenderness, and swelling of the joints are some of the primary indications of disease activity. Nobody likes to hurt and reducing pain and associated tissue damage are goals of RA treatment.

Pain is often the brain’s way of telling us that something isn’t right; it can be an early warning signal of sorts. “Get your hands away from the fire before you seriously get burned!” The sensation of pain may indicate that we need to make a change in some way, e.g., physically, emotionally, spiritually. 

Pain may also be an indication that our body needs something it isn’t getting. For example, if I am not drinking enough water and begin to become dehydrated, I might get a headache, feel weak or dizzy, and have an upset stomach. And then there are times when nothing is wrong but you still feel pain, perhaps due to a malfunctioning nervous system that gets confused and sends misleading messages to/from the brain.

Several factors can influence how we perceive pain, one such factor is vitamin D deficiency which is measured by the 25(OH)D test. A recent study found that vitamin D deficiency was associated with higher pain intensity levels and lower quality of life in patients with widespread pain when compared with a control group. Researchers also found that lower vitamin D levels correlated with abnormal results from nerve conduction studies (Kuru, 2014).

Changes in vitamin D levels in the blood have been associated with inflammatory diseases, such as inflammatory bowel disease, rheumatoid arthritis, lupus, multiple sclerosis, atherosclerosis, or asthma (Wöbke, 2014). A 2012 meta-analysis, which included eight studies investigating the association between vitamin D and RA activity in 2,885 RA patients and 1,084 controls, revealed that the available evidence indicates that lower vitamin D levels are indeed associated with more RA disease activity as measured by DAS28 (disease activity score in 28 joints) (Song, 2012). Subsequent studies have found the same (Kostoglou-Athanassiou, 2012; Abourazzak, 2014; Hong, 2014).

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Vitamin D Deficiency and RA Activity