THE EFFECT OF VITAMIN D ON THE SEVERITY OF DEPRESSION IN PATIENTS WITH RHEUMATOID ARTHRITIS

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Introduction. In recent years, vitamin D acts as an indicator of general health, since vitamin D deficiency has been established not only with bone tissue metabolism, cardiovascular and autoimmune diseases, but also indicators of mental health. Patients with RA have a high prevalence of depression and anxiety [1, 2], as well as their connection with a low level of the main serum metabolite of vitamin D - 25(OH)D [3]. Objective to study the dependence of depressive disorders in patients with RA on vitamin D deficiency in blood serum. Materials and methods. There were 88 women under observation (mean age - 54.2 ± 12.0 years, disease duration - 9.0 [3.5; 16.0] years) with a reliable diagnosis of RA. To assess the presence of depressive symptoms, Beck’s depression questionnaire was used to evaluate the results obtained in points. The level of 25 (OH) D in the serum of RA patients was measured by ELISA using the commercial test system “25-OH-Vitamin D Total” (DRG) and expressed in nmol/l: <25 nmol/l - deficiency, 25-74 - insufficiency, 75-250 - sufficient level. Results and discussion. The results of a psychological study using the Beck scale made it possible to determine the presence of depression in 66% of RA patients (Fig. 1). The mean value of serum levels of 25(OH)D in patients with RA was 50.04 ± 17.49 nmol/l. The vast majority (89.8%) were patients with insufficient serum 25(OH)D levels. In patients with RA with no signs of depression, the level of 25(OH)D showed maximum values (Table 1) and significantly (Mann-Whitney U Test) differed from those in groups of patients with moderate (p = 0.028) and severe depression (p < 0.001); but there were no differences with the groups of patients with mild and moderate depression (p > 0.05). Significant differences in the content of 25(OH)D were also found in patients with minimal and severe (p = 0.003), mild and severe (p = 0.02) depression. Between the level of 25(OH)D and the severity of depression, the Spearman correlation coefficient was found to have a negative average correlation (r = -0.38, n = 88, p < 0.05). A positive relationship was found between 25(OH)D and ESR levels (r = 0.29, n = 73, p < 0.05) and blood calcium (r = 0.37, n = 81, p < 0.05). A positive correlation of weak strength was noted between the level of depression and the intake of corticosteroid hormones (r = 0.22, n = 88, p < 0.05) and their dose (r = 0.26, n = 80, p < 0.05), as well as the number of painful joints (r = 0.25, n = 88, p < 0.05) in patients with RA. Vitamin D is probably indirectly involved in joint inflammation and central sensibilization, which provokes chronic pain and psychological disorders in patients with RA. Reduced quality of life and the development of depression are associated with low levels of vitamin D in 56.3% of the general population [4]. Vitamin D deficiency is associated with musculoskeletal pain in 83.8% of patients with depression and anxiety, and drug therapy aimed at correction of insufficiency 25(OH)D can significantly improve the physical and mental state of these patients [5]. Adding vitamin D to the main therapy is well tolerated by RA patients and can improve psychological indicators through the regulation of neurotransmitter synthesis, immunomodulation, antioxidant properties, by reducing the severity of depression [6]. Conclusion. When conducting an individual assessment and selection of treatment tactics, special attention should be paid to improving metabolic and psychological parameters, since the restoration of the normal level of 25(OH)D can have a positive effect on reducing depression and pain in RA.

About the authors

V A Aleksandrov

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd; Volgograd State Medical University, Volgograd

N V Nikitina

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

L N Shilova

Volgograd State Medical University, Volgograd

N I Aleksandrov

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd; Volgograd State Medical University, Volgograd

N V Emelianov

Volgograd State Medical University, Volgograd

E E Aleksandrova

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

E E Mozgovaya

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd

I A Zborovskaya

Institute for Clinical and Experimental Rheumatology named after A.B. Zborovsky, Volgograd; Volgograd State Medical University, Volgograd

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