Table_1_The Effect of Vitamin D Supplementation on Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis.DOC

Objective Observational studies have shown that vitamin D levels are inversely related to rheumatoid arthritis activity, yet evidence from population interventions remains inconsistent.
Methods: The PubMed, Cochrane Library, Embase, CNKI, VIP, and Wanfang databases were searched for studies published before June 2020. Information was collected about the pain visual analog scale (VAS), Disease Activity Score 28 (DAS28), serum vitamin D level, tender joint count (TJC), swollen joint count (SJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and parathyroid hormone (PTH) research data.
Results: Six studies (n = 438) were included in the meta-analysis. Vitamin D supplementation resulted in a significant improvement in the DAS28 (weighted mean difference (WMD) = −0.41, 95% CI (−0.59, −0.23), P < 0.001), ESR (WMD = −3.40, 95% CI (−6.62, −0.18), P = 0.04) and TJC (WMD = −1.44, 95% CI (−2.74, −0.14), P = 0.03) but not in other outcomes. According to the subgroup analyses, VAS and serum vitamin D were improved in the European ethnic subgroups. TJC and serum vitamin D were improved in the Asian ethnic subgroups. TJC and serum vitamin D were improved in the duration ≤ 12 w subgroups, and the VAS and DAS28 in the duration > 12 w subgroup were different from those of the control group. With a vitamin D dose ≤50,000 IU, only serum vitamin D and TJC improved, and with a vitamin D dose> 50,000 IU, the VAS and DAS28 improved.
Conclusions: Compared with placebo control interventions, vitamin D supplementation seemed to be an effective intervention for patients with rheumatoid arthritis. Different doses of vitamin D and durations of intervention produce different effects.

**研究背景**：已有观察性研究表明，维生素D水平与类风湿关节炎（rheumatoid arthritis）的疾病活动度呈负相关，但人群干预试验的相关证据仍存在不一致性。**研究方法**：检索PubMed、Cochrane图书馆、Embase、中国知网（CNKI）、维普资讯（VIP）及万方数据库中2020年6月之前发表的相关研究，收集疼痛视觉模拟评分（Visual Analog Scale, VAS）、28个关节疾病活动度评分（Disease Activity Score 28, DAS28）、血清维生素D水平、压痛关节计数（Tender Joint Count, TJC）、肿胀关节计数（Swollen Joint Count, SJC）、红细胞沉降率（Erythrocyte Sedimentation Rate, ESR）、C反应蛋白（C-reactive protein, CRP）及甲状旁腺激素（Parathyroid Hormone, PTH）相关研究数据。**研究结果**：共纳入6项研究（总样本量n=438）进行荟萃分析。补充维生素D可显著改善28个关节疾病活动度评分（加权均数差WMD=-0.41，95%置信区间CI：-0.59~-0.23，P<0.001）、红细胞沉降率（WMD=-3.40，95%CI：-6.62~-0.18，P=0.04）及压痛关节计数（WMD=-1.44，95%CI：-2.74~-0.14，P=0.03），但对其余结局指标无显著改善。亚组分析显示：欧洲人群亚组的疼痛视觉模拟评分及血清维生素D水平得到改善；亚洲人群亚组的压痛关节计数及血清维生素D水平得到改善；干预时长≤12周亚组的压痛关节计数及血清维生素D水平得到改善，而干预时长>12周亚组的疼痛视觉模拟评分与28个关节疾病活动度评分与对照组存在显著差异。当维生素D剂量≤50000 IU时，仅血清维生素D水平及压痛关节计数得到改善；当维生素D剂量>50000 IU时，疼痛视觉模拟评分与28个关节疾病活动度评分得到改善。**研究结论**：与安慰剂对照干预相比，补充维生素D对类风湿关节炎患者似乎是一种有效的干预手段。不同剂量的维生素D及不同的干预时长会产生不同的干预效果。