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Взаимосвязь витамина D и остеоартрита - Журнал Терапевтический архив №5 Вопросы ревматологии 2025
Взаимосвязь витамина D и остеоартрита
Кашеварова Н.Г., Алексеева Л.И., Таскина Е.А., Стребкова Е.А., Шарапова Е.П., Савушкина Н.М., Михайлов К.М., Глухова С.И., Алексеева О.Г., Кудинский Д.М., Демин Н.В., Самаркина Е.Ю., Лила А.М. Взаимосвязь витамина D и остеоартрита. Терапевтический архив. 2025;97(5):434–442. DOI: 10.26442/00403660.2025.05.203228
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2025 г.
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Аннотация
Обоснование. Остеоартрит (ОА) является распространенным заболеванием суставов и одной из основных причин инвалидности во всем мире. Роль витамина D в происхождении и развитии ОА до сих пор не ясна, однако она может иметь важное значение как для диагностики, так и для своевременного назначения терапии.
Цель. В одномоментном исследовании оценить взаимосвязь уровня витамина D с клинико-инструментальными параметрами при ОА.
Материалы и методы. В исследование включен 171 пациент в возрасте 40–75 лет с достоверным диагнозом ОА коленных суставов I–III стадии (по Келлгрену–Лоуренсу) согласно классификации Американского колледжа ревматологов, подписавший информированное согласие. Средний возраст пациентов составил 53,5±9,94 года, индекс массы тела (ИМТ) – 29,8±6,4 кг/м2, длительность заболевания 3 [1; 7] года. На каждого больного заполнялась индивидуальная карта, включающая в себя антропометрические показатели, данные анамнеза и клинического осмотра, оценку боли в коленных суставах по Визуальной аналоговой шкале (ВАШ), WOMAC, общего состояния здоровья пациента (ОСЗП). Всем пациентам проводились стандартная рентгенография, ультразвуковое исследование (УЗИ) и магнитно-резонансная томография (МРТ) коленных суставов (WORMS), денситометрия поясничного отдела позвоночника и шейки бедренной кости, лабораторное обследование. Статистическую обработку материала осуществляли с помощью программы Statistica 10.
Результаты. Нормальные значения витамина D (≥30 нг/мл) выявлены у 62 (36,3%) пациентов, пониженные (<30 нг/мл) – у 109 (63,7%) пациентов, при этом недостаточность (<30 нг/мл, но >20 нг/мл) регистрировалась у 66 (38,6%) пациентов, а дефицит (<20 нг/мл) – у 43 (25,1%). По наличию или отсутствию недостаточности/дефицита витамина D пациенты разделены на 3 группы: 1-я группа – пациенты с нормальными значениями витамина D, 2-я группа – с недостаточностью, 3-я группа – с дефицитом. Больные трех групп оказались сопоставимы по возрасту и длительности заболевания, но значимо различались по массе тела, ИМТ, объему талии (с преобладанием этих значений в группах со сниженными значениями витамина D; p<0,05). Также у данных пациентов отмечались значимо выше показатели боли по ВАШ, суммарного WOMAC и его составляющих (боли, скованности и функциональной недостаточности), хуже ОСЗП, хуже данные по индексу KOOS. У большего числа пациентов 2 и 3-й групп наблюдались ОА тазобедренных суставов и суставов кистей, клинически выявленный синовит, плоскостопие и гипотрофия четырехглавых мышц. При УЗИ значимо чаще выявлялись меньшие размеры хрящевой ткани как по переднемедиальной, так и по переднелатеральной поверхности коленного сустава; при МРТ – чаще остеит в медиальных мыщелках бедренной и большеберцовых костей (р<0,05 для всех значений).
Заключение. В проведенном нами исследовании продемонстрировано, что низкие показатели витамина D в крови (недостаточность/дефицит) ассоциируются с более тяжелым течением ОА коленных суставов. Данные пациенты имели большую массу тела, ИМТ, большие значения боли по ВАШ, индексу WOMAC (суммарному и его составляющим), худшие показатели KOOS, ОСЗП, меньшие размеры хряща в медиальных отделах коленного сустава (по данным УЗИ), у них значимо чаще выявлялся остеит в медиальных отделах бедренной и большеберцовой костей при МРТ. Кроме того, чаще наблюдались II и III стадии ОА коленных суставов, ОА других локализаций, клинически выявленный синовит, гипотрофия четырехглавых мышц, плоскостопие.
Ключевые слова: остеоартрит, витамин D, дефицит, недостаточность
Aim. To evaluate the relationship of vitamin D levels with clinical and instrumental parameters in OA in a cross-sectional study.
Materials and methods. The study included 171 patients aged 40–75 with confirmed knee OA according to the American College of Rheumatology (ACR) classification, stage I–III (according to Kellgren and Lawrence). All patients signed informed consent. The mean age was 53.5±9.94 years, body mass index (BMI) was 29.8±6.4 kg/m2, and disease duration was 3 [1; 7] years. For each patient, a case record form was filled out, including anthropometric indicators, medical history, clinical examination data, an assessment of knee joint pain according to the Visual Analog Scale (VAS), WOMAC, and the patient's general health condition (PGHC). All patients underwent standard radiography, knee ultrasound examination and magnetic resonance imaging (MRI) (WORMS), densitometry of the lumbar spine and femoral neck, and laboratory tests. Statistical processing of the data was performed using the Statistica 10 software.
Results. Normal vitamin D values (≥30 ng/mL) were found in 62 (36.3%) patients, low levels (<30 ng/mL) in 109 (63.7%) patients, insufficiency (<30 ng/mL and >20 ng/mL) in 66 (38.6%) patients, and deficiency (<20 ng/mL) in 43 (25.1%). Patients were divided into three groups according to the presence or absence of vitamin D insufficiency/deficiency: Group 1 included patients with normal vitamin D levels, Group 2 included patients with insufficiency, and Group 3 included patients with vitamin D deficiency. Patients of the three groups were comparable in age and disease duration but differed significantly in body weight, BMI, and waist measurement (higher in groups with reduced vitamin D values; p<0.05). Also, these patients had significantly higher VAS pain scores, total WOMAC and its components (pain, stiffness, and dysfunction), PGHC, and worse KOOS. More patients in Groups 2 and 3 had OA of the hip and hand joints, clinically detected synovitis, flat feet, and quadriceps muscle hypotrophy. Ultrasound examination significantly more often revealed a reduction of cartilage tissue on both the anteromedial and anterolateral surfaces of the knee joint; MRI showed more often osteitis in the medial condyles of the femur and tibia (p<0.05 for all values).
Conclusion. Our study demonstrated that low blood vitamin D levels (insufficiency/deficiency) were associated with a more severe knee OA. These patients had a large body weight, BMI, higher VAS pain values, WOMAC index (overall and its components), worse KOOS, PGHC, and smaller cartilage sizes in the medial parts of the knee joint (according to ultrasound); such patients were significantly more likely to have osteitis in the medial parts of the femur and tibia according to MRI. Also, stage II and III knee OA and OA of other localizations, clinically detected synovitis, quadriceps hypotrophy, and flat feet were more common.
Keywords: osteoarthritis, vitamin D, deficiency, insufficiency
Цель. В одномоментном исследовании оценить взаимосвязь уровня витамина D с клинико-инструментальными параметрами при ОА.
Материалы и методы. В исследование включен 171 пациент в возрасте 40–75 лет с достоверным диагнозом ОА коленных суставов I–III стадии (по Келлгрену–Лоуренсу) согласно классификации Американского колледжа ревматологов, подписавший информированное согласие. Средний возраст пациентов составил 53,5±9,94 года, индекс массы тела (ИМТ) – 29,8±6,4 кг/м2, длительность заболевания 3 [1; 7] года. На каждого больного заполнялась индивидуальная карта, включающая в себя антропометрические показатели, данные анамнеза и клинического осмотра, оценку боли в коленных суставах по Визуальной аналоговой шкале (ВАШ), WOMAC, общего состояния здоровья пациента (ОСЗП). Всем пациентам проводились стандартная рентгенография, ультразвуковое исследование (УЗИ) и магнитно-резонансная томография (МРТ) коленных суставов (WORMS), денситометрия поясничного отдела позвоночника и шейки бедренной кости, лабораторное обследование. Статистическую обработку материала осуществляли с помощью программы Statistica 10.
Результаты. Нормальные значения витамина D (≥30 нг/мл) выявлены у 62 (36,3%) пациентов, пониженные (<30 нг/мл) – у 109 (63,7%) пациентов, при этом недостаточность (<30 нг/мл, но >20 нг/мл) регистрировалась у 66 (38,6%) пациентов, а дефицит (<20 нг/мл) – у 43 (25,1%). По наличию или отсутствию недостаточности/дефицита витамина D пациенты разделены на 3 группы: 1-я группа – пациенты с нормальными значениями витамина D, 2-я группа – с недостаточностью, 3-я группа – с дефицитом. Больные трех групп оказались сопоставимы по возрасту и длительности заболевания, но значимо различались по массе тела, ИМТ, объему талии (с преобладанием этих значений в группах со сниженными значениями витамина D; p<0,05). Также у данных пациентов отмечались значимо выше показатели боли по ВАШ, суммарного WOMAC и его составляющих (боли, скованности и функциональной недостаточности), хуже ОСЗП, хуже данные по индексу KOOS. У большего числа пациентов 2 и 3-й групп наблюдались ОА тазобедренных суставов и суставов кистей, клинически выявленный синовит, плоскостопие и гипотрофия четырехглавых мышц. При УЗИ значимо чаще выявлялись меньшие размеры хрящевой ткани как по переднемедиальной, так и по переднелатеральной поверхности коленного сустава; при МРТ – чаще остеит в медиальных мыщелках бедренной и большеберцовых костей (р<0,05 для всех значений).
Заключение. В проведенном нами исследовании продемонстрировано, что низкие показатели витамина D в крови (недостаточность/дефицит) ассоциируются с более тяжелым течением ОА коленных суставов. Данные пациенты имели большую массу тела, ИМТ, большие значения боли по ВАШ, индексу WOMAC (суммарному и его составляющим), худшие показатели KOOS, ОСЗП, меньшие размеры хряща в медиальных отделах коленного сустава (по данным УЗИ), у них значимо чаще выявлялся остеит в медиальных отделах бедренной и большеберцовой костей при МРТ. Кроме того, чаще наблюдались II и III стадии ОА коленных суставов, ОА других локализаций, клинически выявленный синовит, гипотрофия четырехглавых мышц, плоскостопие.
Ключевые слова: остеоартрит, витамин D, дефицит, недостаточность
________________________________________________
Aim. To evaluate the relationship of vitamin D levels with clinical and instrumental parameters in OA in a cross-sectional study.
Materials and methods. The study included 171 patients aged 40–75 with confirmed knee OA according to the American College of Rheumatology (ACR) classification, stage I–III (according to Kellgren and Lawrence). All patients signed informed consent. The mean age was 53.5±9.94 years, body mass index (BMI) was 29.8±6.4 kg/m2, and disease duration was 3 [1; 7] years. For each patient, a case record form was filled out, including anthropometric indicators, medical history, clinical examination data, an assessment of knee joint pain according to the Visual Analog Scale (VAS), WOMAC, and the patient's general health condition (PGHC). All patients underwent standard radiography, knee ultrasound examination and magnetic resonance imaging (MRI) (WORMS), densitometry of the lumbar spine and femoral neck, and laboratory tests. Statistical processing of the data was performed using the Statistica 10 software.
Results. Normal vitamin D values (≥30 ng/mL) were found in 62 (36.3%) patients, low levels (<30 ng/mL) in 109 (63.7%) patients, insufficiency (<30 ng/mL and >20 ng/mL) in 66 (38.6%) patients, and deficiency (<20 ng/mL) in 43 (25.1%). Patients were divided into three groups according to the presence or absence of vitamin D insufficiency/deficiency: Group 1 included patients with normal vitamin D levels, Group 2 included patients with insufficiency, and Group 3 included patients with vitamin D deficiency. Patients of the three groups were comparable in age and disease duration but differed significantly in body weight, BMI, and waist measurement (higher in groups with reduced vitamin D values; p<0.05). Also, these patients had significantly higher VAS pain scores, total WOMAC and its components (pain, stiffness, and dysfunction), PGHC, and worse KOOS. More patients in Groups 2 and 3 had OA of the hip and hand joints, clinically detected synovitis, flat feet, and quadriceps muscle hypotrophy. Ultrasound examination significantly more often revealed a reduction of cartilage tissue on both the anteromedial and anterolateral surfaces of the knee joint; MRI showed more often osteitis in the medial condyles of the femur and tibia (p<0.05 for all values).
Conclusion. Our study demonstrated that low blood vitamin D levels (insufficiency/deficiency) were associated with a more severe knee OA. These patients had a large body weight, BMI, higher VAS pain values, WOMAC index (overall and its components), worse KOOS, PGHC, and smaller cartilage sizes in the medial parts of the knee joint (according to ultrasound); such patients were significantly more likely to have osteitis in the medial parts of the femur and tibia according to MRI. Also, stage II and III knee OA and OA of other localizations, clinically detected synovitis, quadriceps hypotrophy, and flat feet were more common.
Keywords: osteoarthritis, vitamin D, deficiency, insufficiency
Полный текст
Список литературы
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36. Samuels J, Krasnokutsky S, Abramson SB. Osteoarthritis: a tale of three tissues. Bull NYU Hosp Jt Dis. 2008;66:244e50.
37. Kwan Tat S, Lajeunesse D, Pelletier JP, Martel-Pelletier J. Targeting subchondral bone for treating osteoarthritis: what is the evidence? Best Pract Res Clin Rheumatol. 2010;24:51-70. DOI:10.1016/j.berh.2009.08.004
38. Dean DD, Schwartz Z, Schmitz J, et al. Vitamin D regulation of metalloproteinase activity in matrix vesicles. Connect Tissue Res. 1996;35:331-6. DOI:10.3109/03008209609029208
39. Пигарова Е.А., Дзеранова Л.К., Яценко Д.А. Витамин D – вопросы всасывания и метаболизма в норме и при заболеваниях желудочно-кишечного тракта. Ожирение и метаболизм. 2022;19(1):123-33 [Pigarova EA, Dzeranova LК, Yatsenko DA. Absorption and metabolism of vitamin D in health and in gastrointestinal tract diseases. Obesity and Metabolism. 2022;19(1):123-33 (in Russian)]. DOI:10.14341/omet12835
40. Hyppönen E, Boucher BJ. Adiposity, vitamin D requirements, and clinical implications for obesity-related metabolic abnormalities. Nutr Rev. 2018;76:678-92. DOI:10.1093/nutrit/nuy034
41. Marquina C, Mousa A, Scragg R, De Courten B. Vitamin D and cardiometabolic disorders: A review of current evidence, genetic determinants and pathomechanisms. Obes Rev. 2018;20:262-77. DOI:10.1111/obr.12793
42. Pramono A, Jocken JWE, Goossens GH, Blaak EE. Vitamin D release across abdominal adipose tissue in lean and obese men: The effect of ß-adrenergic stimulation. Physiol. Rep. 2019;7:e14308. DOI:10.14814/phy2.14308
43. Liang Z, Wang Z, Liu X, He Y. Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management. Front Nutr. 2024;11:1416344. DOI:10.3389/fnut.2024.1416344
44. Segal NA, Glass NA, Torner J, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010;18(6):769-75. DOI:10.1016/j.joca.2010.02.002
45. Barker T, Henriksen VT, Rogers VE, et al. Vitamin D deficiency associates with γ-tocopherol and quadriceps weakness but not inflammatory cytokines in subjects with knee osteoarthritis. Redox Biol. 2014;2(1):466-74. DOI:10.1016/j.redox.2014.01.024
46. Glover TL, Goodin BR, King CD, et al. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain. 2015;31:1060-7. DOI:10.1097/AJP.0000000000000210
2. Yao Q, Wu X, Tao C, at al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8:56. DOI:10.1038/s41392-023-01330-w
3. Arthritis Foundation Osteoarthritis Symptoms. Available at: https://www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php. Accessed: 02.01.2019.
4. Constantino de Campos G, Mundi R, Whittington C, at al. Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses. Ther Adv Musculoskelet Dis. 2020;12:1759720x20981219. DOI:10.1177/1759720X20981219
5. Mabey T, Honsawek S. Role of Vitamin D in osteoarthritis: molecular, cellular, and clinical perspectives. Int J Endocrinol. 2015:383918. DOI:10.1155/2015/383918
6. Perry TA, Parkes MJ, Hodgson R, et al. Efect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. BMC Musculoskelet Disord. 2019;20(1):76. DOI:10.1186/s12891-019-2424-4
7. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5:2502-21. DOI:10.3390/nu5072502
8. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59:881-6. DOI:10.2310/JIM.0b013e31821b8755
9. Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12(7):2097. DOI:10.3390/nu12072097
10. National Institutes of Health, Office of Dietary Supplements, “Vitamin D – Fact Sheet for Consumers,” 2021. Available at: https://ods.od.nih.gov/factsheets/Vitamind-Consumer/ Accessed: 01.02.2025.
11. Dedov II, Melnichenko GA, Mokrysheva NG, et al. Draft federal clinical practice guidelines for the diagnosis, treatment, and prevention of vitamin D deficiency. Osteoporosis and Bone Diseases. 2021;24(4):4-26 (in Russian). DOI:10.14341/osteo12937
12. Avdeeva VA, Suplotova LA, Pigarova EA, et al. Vitamin D deficiency in Russia: the first results of a registered, non-interventional study of the frequency of vitamin D deficiency and insufficiency in various geographic regions of the country. Problems of Endocrinology. 2021;67(2):84-92 (in Russian). DOI:10.14341/probl12736
13. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103(4):1033-44. DOI:10.3945/ajcn.115.120873
14. McChesney C, Singer A, Duquette D, et al. Do not routinely test for vitamin D. BMJ. 2022;378:e070270. DOI:10.1136/bmj-2022-070270
15. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109(8):1907-47. DOI:10.1210/clinem/dgae290
16. Heidari B, Shokri Shirvani J, Firouzjahi A, et al. Association between nonspecific skeletal pain and vitamin D deficiency. Int J Rheumatol. 2010;13:340-6. DOI:10.1111/j.1756-185X.2010.01561.x
17. Pérez-López FR. Vitamin D and its implications for musculoskeletal health in women: an update. Maturitas. 2007;58:117-37. DOI:10.1016/j.maturitas.2007.05.002
18. Chaganti RK, Parimi N, Cawthon P, et al. Association of 25-hydroxyvitamin D with prevalent osteoarthritis of the hip in elderly men: the osteoporotic fractures in men study. Arthritis Rheum. 2010;62:511-4. DOI:10.1002/art.27241
19. Goula T, Kouskoukis A, Drosos G, et al. Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country. J Orthop Traumatol. 2015;16:35-9. DOI:10.1007/s10195-014-0322-y
20. Bischoff-Ferrari HA, Zhang Y, Kiel DP, Felson DT. Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis. Arthritis Rheum. 2005;53:821-6. DOI:10.1002/art.21601
21. Mäkinen TJ, Alm JJ, Laine H, et al. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone. 2007;40:1041-7. DOI:10.1016/j.bone.2006.11.013
22. Bergink AP, Uitterlinden AG, Leeuwen JP, et al. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: the Rotterdam Study. J Clin Rheumatol. 2009;15:230-7. DOI:10.1097/RHU.0b013e3181b08f20
23. Ding C, Cicuttini F, Parameswaran V, et al. Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian older adult cohort study. Arthritis Rheum. 2009;60:1381-9. DOI:10.1002/art.24486
24. Anari H, Enteshari-Moghaddam A, Abdolzadeh Y. Association between serum Vitamin D deficiency and Knee Osteoarthritis Mediterr J Rheumatol. 2019;30(4):216-9. DOI:10.31138/mjr.30.4.216
25. Felson DT, Niu J, Clancy M, et al. Low serum levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum. 2007;56:129-36. DOI:10.1002/art.22292
26. Sanghi D, Mishra A, Sharma AC. Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res. 2013;471:3556-62. DOI:10.1007/s11999-013-3201-6
27. Gao XR, Chen YS, Deng W. The effect of vitamin D supplementation on knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg. 2017;46:14-20. DOI:10.1016/j.ijsu.2017.08.010
28. Beaudart C, Lengele L, Leclercq V, et al. Symptomatic efficacy of pharmacological treatments for knee osteoarthritis: a systematic review and a network meta-analysis with a 6-month time horizon. Drugs. 2020;80:1947-59. DOI:10.1007/s40265-020-01423-8
29. Mathieu S, Soubrier M, Peirs C, et al. A meta-analysis of the impact of nutritional supplementation on osteoarthritis symptoms. Nutrients. 2022;14:1607. DOI:10.3390/nu14081607
30. Zhao ZX, He Y, Peng LH, et al. Does vitamin D improve symptomatic and structural outcomes in knee osteoarthritis? A systematic review and meta-analysis. Aging Clin Exp Res. 2021;33:2393-403. DOI:10.1007/s40520-020-01778-8
31. McAlindon T, LaValley M, Schneider E. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis a randomized controlled trial. JAMA. 2013;309(2):155-62. DOI:10.1001/jama.2012.164487
32. Jin X, Jones G, Cicuttini F, et al. Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients with Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2016;315:1005-13. DOI:10.1001/jama.2016.1961
33. Buralkina N A, Arutyunova EE, Vlasova GA. Global vitamin D status problems: causes, pathogenetic mechanisms, treatment, prevention measures. Medical Council. 2018;12:152-8 (in Russian). DOI:10.21518/2079-701X-2018-12-152-158
34. Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: Global perspective. Ann Epi. 2009;19:468-83. DOI:10.1016/j.annepidem.2009.03.021
35. Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008;88:558-642. DOI:10.1093/ajcn/88.2.558s
36. Samuels J, Krasnokutsky S, Abramson SB. Osteoarthritis: a tale of three tissues. Bull NYU Hosp Jt Dis. 2008;66:244e50.
37. Kwan Tat S, Lajeunesse D, Pelletier JP, Martel-Pelletier J. Targeting subchondral bone for treating osteoarthritis: what is the evidence? Best Pract Res Clin Rheumatol. 2010;24:51-70. DOI:10.1016/j.berh.2009.08.004
38. Dean DD, Schwartz Z, Schmitz J, et al. Vitamin D regulation of metalloproteinase activity in matrix vesicles. Connect Tissue Res. 1996;35:331-6. DOI:10.3109/03008209609029208
39. Pigarova EA, Dzeranova LК, Yatsenko DA. Absorption and metabolism of vitamin D in health and in gastrointestinal tract diseases. Obesity and Metabolism. 2022;19(1):123-33 (in Russian). DOI:10.14341/omet12835
40. Hyppönen E, Boucher BJ. Adiposity, vitamin D requirements, and clinical implications for obesity-related metabolic abnormalities. Nutr Rev. 2018;76:678-92. DOI:10.1093/nutrit/nuy034
41. Marquina C, Mousa A, Scragg R, De Courten B. Vitamin D and cardiometabolic disorders: A review of current evidence, genetic determinants and pathomechanisms. Obes Rev. 2018;20:262-77. DOI:10.1111/obr.12793
42. Pramono A, Jocken JWE, Goossens GH, Blaak EE. Vitamin D release across abdominal adipose tissue in lean and obese men: The effect of ß-adrenergic stimulation. Physiol. Rep. 2019;7:e14308. DOI:10.14814/phy2.14308
43. Liang Z, Wang Z, Liu X, He Y. Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management. Front Nutr. 2024;11:1416344. DOI:10.3389/fnut.2024.1416344
44. Segal NA, Glass NA, Torner J, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010;18(6):769-75. DOI:10.1016/j.joca.2010.02.002
45. Barker T, Henriksen VT, Rogers VE, et al. Vitamin D deficiency associates with γ-tocopherol and quadriceps weakness but not inflammatory cytokines in subjects with knee osteoarthritis. Redox Biol. 2014;2(1):466-74. DOI:10.1016/j.redox.2014.01.024
46. Glover TL, Goodin BR, King CD, et al. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain. 2015;31:1060-7. DOI:10.1097/AJP.0000000000000210
2. Yao Q, Wu X, Tao C, at al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8:56. DOI:10.1038/s41392-023-01330-w
3. Arthritis Foundation Osteoarthritis Symptoms. Available at: https://www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php. Accessed: 02.01.2019.
4. Constantino de Campos G, Mundi R, Whittington C, at al. Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses. Ther Adv Musculoskelet Dis. 2020;12:1759720x20981219. DOI:10.1177/1759720X20981219
5. Mabey T, Honsawek S. Role of Vitamin D in osteoarthritis: molecular, cellular, and clinical perspectives. Int J Endocrinol. 2015:383918. DOI:10.1155/2015/383918
6. Perry TA, Parkes MJ, Hodgson R, et al. Efect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. BMC Musculoskelet Disord. 2019;20(1):76. DOI:10.1186/s12891-019-2424-4
7. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5:2502-21. DOI:10.3390/nu5072502
8. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59:881-6. DOI:10.2310/JIM.0b013e31821b8755
9. Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12(7):2097. DOI:10.3390/nu12072097
10. National Institutes of Health, Office of Dietary Supplements, “Vitamin D – Fact Sheet for Consumers,” 2021. Available at: https://ods.od.nih.gov/factsheets/Vitamind-Consumer/ Accessed: 01.02.2025.
11. Дедов И.И., Мельниченко Г.А., Мокрышева Н.Г., и др. Проект Федеральных клинических рекомендаций по диагностике, лечению и профилактике дефицита витамина Д. Остеопороз и остеопатии. 2021;24(4):4-26 [Dedov II, Melnichenko GA, Mokrysheva NG, et al. Draft federal clinical practice guidelines for the diagnosis, treatment, and prevention of vitamin D deficiency. Osteoporosis and Bone Diseases. 2021;24(4):4-26 (in Russian)]. DOI:10.14341/osteo12937
12. Суплотова Л.А., Авдеева В.А., Пигарова Е.А., и др. Дефицит витамина D в России: первые результаты регистрового неинтервенционного исследования частоты дефицита и недостаточности витамина D в различных географических регионах страны. Проблемы эндокринологии. 2021;67(2):84-92 [Avdeeva VA, Suplotova LA, Pigarova EA, et al. Vitamin D deficiency in Russia: the first results of a registered, non-interventional study of the frequency of vitamin D deficiency and insufficiency in various geographic regions of the country. Problems of Endocrinology. 2021;67(2):84-92 (in Russian)]. DOI:10.14341/probl12736
13. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103(4):1033-44. DOI:10.3945/ajcn.115.120873
14. McChesney C, Singer A, Duquette D, et al. Do not routinely test for vitamin D. BMJ. 2022;378:e070270. DOI:10.1136/bmj-2022-070270
15. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109(8):1907-47. DOI:10.1210/clinem/dgae290
16. Heidari B, Shokri Shirvani J, Firouzjahi A, et al. Association between nonspecific skeletal pain and vitamin D deficiency. Int J Rheumatol. 2010;13:340-6. DOI:10.1111/j.1756-185X.2010.01561.x
17. Pérez-López FR. Vitamin D and its implications for musculoskeletal health in women: an update. Maturitas. 2007;58:117-37. DOI:10.1016/j.maturitas.2007.05.002
18. Chaganti RK, Parimi N, Cawthon P, et al. Association of 25-hydroxyvitamin D with prevalent osteoarthritis of the hip in elderly men: the osteoporotic fractures in men study. Arthritis Rheum. 2010;62:511-4. DOI:10.1002/art.27241
19. Goula T, Kouskoukis A, Drosos G, et al. Vitamin D status in patients with knee or hip osteoarthritis in a Mediterranean country. J Orthop Traumatol. 2015;16:35-9. DOI:10.1007/s10195-014-0322-y
20. Bischoff-Ferrari HA, Zhang Y, Kiel DP, Felson DT. Positive association between serum 25-hydroxyvitamin D level and bone density in osteoarthritis. Arthritis Rheum. 2005;53:821-6. DOI:10.1002/art.21601
21. Mäkinen TJ, Alm JJ, Laine H, et al. The incidence of osteopenia and osteoporosis in women with hip osteoarthritis scheduled for cementless total joint replacement. Bone. 2007;40:1041-7. DOI:10.1016/j.bone.2006.11.013
22. Bergink AP, Uitterlinden AG, Leeuwen JP, et al. Vitamin D status, bone mineral density, and the development of radiographic osteoarthritis of the knee: the Rotterdam Study. J Clin Rheumatol. 2009;15:230-7. DOI:10.1097/RHU.0b013e3181b08f20
23. Ding C, Cicuttini F, Parameswaran V, et al. Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: the Tasmanian older adult cohort study. Arthritis Rheum. 2009;60:1381-9. DOI:10.1002/art.24486
24. Anari H, Enteshari-Moghaddam A, Abdolzadeh Y. Association between serum Vitamin D deficiency and Knee Osteoarthritis Mediterr J Rheumatol. 2019;30(4):216-9. DOI:10.31138/mjr.30.4.216
25. Felson DT, Niu J, Clancy M, et al. Low serum levels of vitamin D and worsening of knee osteoarthritis: results of two longitudinal studies. Arthritis Rheum. 2007;56:129-36. DOI:10.1002/art.22292
26. Sanghi D, Mishra A, Sharma AC. Does vitamin D improve osteoarthritis of the knee: a randomized controlled pilot trial. Clin Orthop Relat Res. 2013;471:3556-62. DOI:10.1007/s11999-013-3201-6
27. Gao XR, Chen YS, Deng W. The effect of vitamin D supplementation on knee osteoarthritis: A meta-analysis of randomized controlled trials. Int J Surg. 2017;46:14-20. DOI:10.1016/j.ijsu.2017.08.010
28. Beaudart C, Lengele L, Leclercq V, et al. Symptomatic efficacy of pharmacological treatments for knee osteoarthritis: a systematic review and a network meta-analysis with a 6-month time horizon. Drugs. 2020;80:1947-59. DOI:10.1007/s40265-020-01423-8
29. Mathieu S, Soubrier M, Peirs C, et al. A meta-analysis of the impact of nutritional supplementation on osteoarthritis symptoms. Nutrients. 2022;14:1607. DOI:10.3390/nu14081607
30. Zhao ZX, He Y, Peng LH, et al. Does vitamin D improve symptomatic and structural outcomes in knee osteoarthritis? A systematic review and meta-analysis. Aging Clin Exp Res. 2021;33:2393-403. DOI:10.1007/s40520-020-01778-8
31. McAlindon T, LaValley M, Schneider E. Effect of vitamin D supplementation on progression of knee pain and cartilage volume loss in patients with symptomatic osteoarthritis a randomized controlled trial. JAMA. 2013;309(2):155-62. DOI:10.1001/jama.2012.164487
32. Jin X, Jones G, Cicuttini F, et al. Effect of Vitamin D Supplementation on Tibial Cartilage Volume and Knee Pain Among Patients with Symptomatic Knee Osteoarthritis: A Randomized Clinical Trial. JAMA. 2016;315:1005-13. DOI:10.1001/jama.2016.1961
33. Буралкина Н.А., Арутюнова Е.Э., Власова Г.А. Глобальные проблемы витамин-D-статуса: причины, патогенетические механизмы, лечение, меры профилактики. Медицинский Совет. 2018;12:152-8 [Buralkina N A, Arutyunova EE, Vlasova GA. Global vitamin D status problems: causes, pathogenetic mechanisms, treatment, prevention measures. Medical Council. 2018;12:152-8 (in Russian)]. DOI:10.21518/2079-701X-2018-12-152-158
34. Garland CF, Gorham ED, Mohr SB, Garland FC. Vitamin D for cancer prevention: Global perspective. Ann Epi. 2009;19:468-83. DOI:10.1016/j.annepidem.2009.03.021
35. Yetley EA. Assessing the vitamin D status of the US population. Am J Clin Nutr. 2008;88:558-642. DOI:10.1093/ajcn/88.2.558s
36. Samuels J, Krasnokutsky S, Abramson SB. Osteoarthritis: a tale of three tissues. Bull NYU Hosp Jt Dis. 2008;66:244e50.
37. Kwan Tat S, Lajeunesse D, Pelletier JP, Martel-Pelletier J. Targeting subchondral bone for treating osteoarthritis: what is the evidence? Best Pract Res Clin Rheumatol. 2010;24:51-70. DOI:10.1016/j.berh.2009.08.004
38. Dean DD, Schwartz Z, Schmitz J, et al. Vitamin D regulation of metalloproteinase activity in matrix vesicles. Connect Tissue Res. 1996;35:331-6. DOI:10.3109/03008209609029208
39. Пигарова Е.А., Дзеранова Л.К., Яценко Д.А. Витамин D – вопросы всасывания и метаболизма в норме и при заболеваниях желудочно-кишечного тракта. Ожирение и метаболизм. 2022;19(1):123-33 [Pigarova EA, Dzeranova LК, Yatsenko DA. Absorption and metabolism of vitamin D in health and in gastrointestinal tract diseases. Obesity and Metabolism. 2022;19(1):123-33 (in Russian)]. DOI:10.14341/omet12835
40. Hyppönen E, Boucher BJ. Adiposity, vitamin D requirements, and clinical implications for obesity-related metabolic abnormalities. Nutr Rev. 2018;76:678-92. DOI:10.1093/nutrit/nuy034
41. Marquina C, Mousa A, Scragg R, De Courten B. Vitamin D and cardiometabolic disorders: A review of current evidence, genetic determinants and pathomechanisms. Obes Rev. 2018;20:262-77. DOI:10.1111/obr.12793
42. Pramono A, Jocken JWE, Goossens GH, Blaak EE. Vitamin D release across abdominal adipose tissue in lean and obese men: The effect of ß-adrenergic stimulation. Physiol. Rep. 2019;7:e14308. DOI:10.14814/phy2.14308
43. Liang Z, Wang Z, Liu X, He Y. Confronting the global obesity epidemic: investigating the role and underlying mechanisms of vitamin D in metabolic syndrome management. Front Nutr. 2024;11:1416344. DOI:10.3389/fnut.2024.1416344
44. Segal NA, Glass NA, Torner J, et al. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort. Osteoarthritis Cartilage. 2010;18(6):769-75. DOI:10.1016/j.joca.2010.02.002
45. Barker T, Henriksen VT, Rogers VE, et al. Vitamin D deficiency associates with γ-tocopherol and quadriceps weakness but not inflammatory cytokines in subjects with knee osteoarthritis. Redox Biol. 2014;2(1):466-74. DOI:10.1016/j.redox.2014.01.024
46. Glover TL, Goodin BR, King CD, et al. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain. 2015;31:1060-7. DOI:10.1097/AJP.0000000000000210
________________________________________________
2. Yao Q, Wu X, Tao C, at al. Osteoarthritis: pathogenic signaling pathways and therapeutic targets. Signal Transduct Target Ther. 2023;8:56. DOI:10.1038/s41392-023-01330-w
3. Arthritis Foundation Osteoarthritis Symptoms. Available at: https://www.arthritis.org/about-arthritis/types/osteoarthritis/symptoms.php. Accessed: 02.01.2019.
4. Constantino de Campos G, Mundi R, Whittington C, at al. Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses. Ther Adv Musculoskelet Dis. 2020;12:1759720x20981219. DOI:10.1177/1759720X20981219
5. Mabey T, Honsawek S. Role of Vitamin D in osteoarthritis: molecular, cellular, and clinical perspectives. Int J Endocrinol. 2015:383918. DOI:10.1155/2015/383918
6. Perry TA, Parkes MJ, Hodgson R, et al. Efect of Vitamin D supplementation on synovial tissue volume and subchondral bone marrow lesion volume in symptomatic knee osteoarthritis. BMC Musculoskelet Disord. 2019;20(1):76. DOI:10.1186/s12891-019-2424-4
7. Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5:2502-21. DOI:10.3390/nu5072502
8. Aranow C. Vitamin D and the immune system. J Investig Med. 2011;59:881-6. DOI:10.2310/JIM.0b013e31821b8755
9. Charoenngam N, Holick MF. Immunologic Effects of Vitamin D on Human Health and Disease. Nutrients. 2020;12(7):2097. DOI:10.3390/nu12072097
10. National Institutes of Health, Office of Dietary Supplements, “Vitamin D – Fact Sheet for Consumers,” 2021. Available at: https://ods.od.nih.gov/factsheets/Vitamind-Consumer/ Accessed: 01.02.2025.
11. Dedov II, Melnichenko GA, Mokrysheva NG, et al. Draft federal clinical practice guidelines for the diagnosis, treatment, and prevention of vitamin D deficiency. Osteoporosis and Bone Diseases. 2021;24(4):4-26 (in Russian). DOI:10.14341/osteo12937
12. Avdeeva VA, Suplotova LA, Pigarova EA, et al. Vitamin D deficiency in Russia: the first results of a registered, non-interventional study of the frequency of vitamin D deficiency and insufficiency in various geographic regions of the country. Problems of Endocrinology. 2021;67(2):84-92 (in Russian). DOI:10.14341/probl12736
13. Cashman KD, Dowling KG, Škrabáková Z, et al. Vitamin D deficiency in Europe: pandemic? Am J Clin Nutr. 2016;103(4):1033-44. DOI:10.3945/ajcn.115.120873
14. McChesney C, Singer A, Duquette D, et al. Do not routinely test for vitamin D. BMJ. 2022;378:e070270. DOI:10.1136/bmj-2022-070270
15. Demay MB, Pittas AG, Bikle DD, et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2024;109(8):1907-47. DOI:10.1210/clinem/dgae290
16. Heidari B, Shokri Shirvani J, Firouzjahi A, et al. Association between nonspecific skeletal pain and vitamin D deficiency. Int J Rheumatol. 2010;13:340-6. DOI:10.1111/j.1756-185X.2010.01561.x
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Авторы
Н.Г. Кашеварова*1, Л.И. Алексеева1,2, Е.А. Таскина1, Е.А. Стребкова1, Е.П. Шарапова1, Н.М. Савушкина1, К.М. Михайлов1, С.И. Глухова1, О.Г. Алексеева1, Д.М. Кудинский1, Н.В. Демин1, Е.Ю. Самаркина1, А.М. Лила1,2
1ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*nat-kash@yandex.ru
1Nasonova Research Institute of Rheumatology, Moscow, Russia;
2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*nat-kash@yandex.ru
1ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия
*nat-kash@yandex.ru
________________________________________________
1Nasonova Research Institute of Rheumatology, Moscow, Russia;
2Russian Medical Academy of Continuous Professional Education, Moscow, Russia
*nat-kash@yandex.ru
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