Prevalence of Parathyroid Disorders and Vitamin D Deficiency in Patients with IMRD | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence of Parathyroid Disorders and Vitamin D Deficiency in Patients with IMRD Lucilaine Furtado Hermenegildo, Gabriella Stefenoni Kruger This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7745779/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Vitamin D deficiency and parathyroid dysfunction may play a role in immune-mediated rheumatic diseases (IMRD). This study aimed to investigate their prevalence, their relationship with disease activity, and the impact of glucocorticoid use. Methods We conducted a cross-sectional and longitudinal study including 40 adult patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SpA). Serum 25(OH)D (vitamin D), parathyroid hormone (PTH), and C-reactive protein (CRP) were measured, along with disease activity indices: DAS28 for RA, SLEDAI for SLE, and ASDAS for SpA. Correlations were tested using Spearman’s rho, with p < 0.05 considered statistically significant. Results Mean serum vitamin D levels were reduced across all groups (RA ≈ 38 ng/mL, SLE ≈ 34 ng/mL, SpA ≈ 39 ng/mL). Vitamin D showed a weak negative correlation with disease activity. PTH values fluctuated but showed no clear correlation. Glucocorticoid use correlated with higher activity scores, reflecting clinical practice. Figure 1 illustrates vitamin D, PTH, and activity scores by disease group. Conclusion Vitamin D deficiency is prevalent in IMRD and may contribute to increased inflammatory activity, although associations are weak. Parathyroid dysfunction did not show a consistent link with disease activity. Glucocorticoid use was associated with more severe cases. Further longitudinal studies are warranted to clarify the impact of vitamin D supplementation and the long-term metabolic consequences of glucocorticoids in IMRD. Vitamin D deficiency Parathyroid hormone Rheumatoid arthritis Systemic lupus erythematosus Spondyloarthritis Disease activity Figures Figure 1 Introduction Vitamin D plays a crucial role in bone metabolism and immune modulation. Deficiency has been linked to several autoimmune and inflammatory conditions, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SpA) ( 1 ). Beyond its calcemic effects, vitamin D regulates antigen-presenting cells, reduces expression of pro-inflammatory cytokines such as IL-6, IL-17, and TNF-α, and promotes tolerogenic immune responses ( 4 ). Parathyroid hormone (PTH) regulates calcium and vitamin D metabolism. Previous studies have suggested that unsuppressed parathyroid hormone levels may occur in patients with autoimmune and inflammatory rheumatic diseases, with implications for vitamin D supplementation ( 1 ). Although hyperparathyroidism has been described in some patients with autoimmune conditions, its direct association with systemic inflammatory activity remains unclear ( 2 , 3 ). Glucocorticoids, although commonly used to control inflammation, accelerate vitamin D metabolism and may contribute to bone loss ( 4 ). Considering these mechanisms, this study aimed to assess the prevalence of vitamin D deficiency and parathyroid dysfunction in IMRD and to explore their correlation with disease activity indices (DAS28 for RA, SLEDAI for SLE, and ASDAS for SpA). Methods We analyzed 40 consecutive patients ≥ 18 years old followed at the Rheumatology Outpatient Clinic of a tertiary hospital. Patients were randomly selected from RA, SLE, and SpA clinics. Serum vitamin D, PTH, and CRP were retrieved from records, along with disease activity indices (DAS28, SLEDAI, ASDAS). Three most recent results were considered, and the latest value was used. Glucocorticoid use was documented (yes/no, dose). Statistical analysis: quantitative variables were tested for normality (Kolmogorov–Smirnov). Means ± SD or medians were reported. Comparisons between groups used t-test or Kruskal–Wallis. Spearman’s rho was applied for correlations (α = 0.05). Analyses were performed using SPSS 25.0. Ethical aspects: The study complied with the Declaration of Helsinki and was approved by the local Research Ethics Committee (CEP-UFTM). Results Among the 40 patients analyzed (RA=~20, SLE=~12, SpA=~8), vitamin D levels were below the recommended 30 ng/mL in most patients. RA patients had mean vitamin D ≈38 ng/mL, SLE ≈34 ng/mL, SpA ≈39 ng/mL. PTH values varied widely without consistent patterns. Activity scores averaged 2.5–3.0 across groups. Figure 1 shows mean values of vitamin D, PTH, and disease activity indices (DAS28, SLEDAI, ASDAS) for RA, SLE, and SpA. Discussion Our results confirm a high prevalence of vitamin D deficiency across IMRD. Although a weak inverse association with disease activity was observed, this correlation was not strong enough to suggest a direct causal role. This is consistent with previous observational studies. PTH levels did not correlate with disease activity, indicating that parathyroid dysfunction may not drive systemic inflammation. Nonetheless, secondary hyperparathyroidism due to chronic vitamin D deficiency may contribute to long-term skeletal complications. Glucocorticoid use was associated with higher activity scores, reflecting that patients with severe inflammation are more frequently treated. However, long-term glucocorticoid therapy may worsen bone metabolism and vitamin D homeostasis, reinforcing the need for careful monitoring. Conclusion Vitamin D deficiency is highly prevalent in IMRD patients and may play a role in disease modulation. PTH did not correlate with inflammatory activity, whereas glucocorticoid use was linked with more severe cases. Further longitudinal studies are needed to clarify whether vitamin D supplementation improves outcomes in RA, SLE, and SpA. Declarations Consent to Participate This study was conducted in accordance with the principles of the Declaration of Helsinki. Given that data collection relied exclusively on medical records, the requirement for individual informed consent was waived by the Research Ethics Committee (CEP-UFTM), in accordance with CNS Resolution 466/2012. Funding This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. Author Contribution LFH conducted the research, collected and analyzed the data, and wrote the manuscript. GSK supervised the project, provided guidance throughout the study, and critically reviewed the manuscript. Both authors approved the final version of the manuscript Ethics Approval The study protocol was reviewed and approved by the Research Ethics Committee of the Universidade Federal do Triângulo Mineiro (CEP-UFTM), under protocol number CAAE: 80804724.0.0000.8667. References Sainaghi PP, Bellan M, Antonini G, Bellomo G, Pirisi M. Unsuppressed parathyroid hormone in patients with autoimmune/inflammatory rheumatic diseases. Rheumatology., Alejandro-Posso V, Medellín J, Kaimoto C, Cañas M, Tobo CA. GJ. Rheumatological diseases in patients with primary hyperparathyroidism. Rheumatology. 2022. 3. Güneş E, Güneş M. Increased prevalence of autoimmune rheumatologic diseases in patients with primary hyperparathyroidism. Cureus. 2023. 4. Charoenngam N. Vitamin D and rheumatic diseases: a review of clinical evidence. Int J Mol Sci. 2021;22:10659. Ethics Approval The study protocol was reviewed and approved by the Research Ethics Committee of the. Universidade Federal do Triângulo Mineiro (CEP-UFTM), under protocol number CAAE: 80804724.0.0000.8667. Consent to Participate. This study was conducted in accordance with the principles of the Declaration of Helsinki. Given that data collection relied exclusively on medical records, the requirement for individual informed consent was waived by the Research Ethics Committee (CEP-UFTM), in accordance with CNS Resolution 466/2012. Funding This research. received no specific grant from any funding agency, commercial, or not-for-profit sectors. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7745779","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":534200413,"identity":"29502067-45c6-41a9-a057-6d536dbc6808","order_by":0,"name":"Lucilaine Furtado 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14:04:48","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":17940,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7745779/v1/bf4182d7116cc087a47fb700.html"},{"id":94409515,"identity":"230e8482-8084-4b7e-8c27-be03cdc5d556","added_by":"auto","created_at":"2025-10-27 14:04:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":138168,"visible":true,"origin":"","legend":"\u003cp\u003eMean serum vitamin D, PTH, and disease activity scores by disease group (DAS28 for RA, SLEDAI for SLE, ASDAS for SpA).\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7745779/v1/e40c7dbbd135a26457a69235.png"},{"id":94490559,"identity":"1398269b-329c-4634-b753-824d3b0397ec","added_by":"auto","created_at":"2025-10-27 17:12:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":398110,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7745779/v1/3c39999c-2241-4a35-a51a-2ad5bc88182c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Parathyroid Disorders and Vitamin D Deficiency in Patients with IMRD","fulltext":[{"header":"Introduction","content":"\u003cp\u003eVitamin D plays a crucial role in bone metabolism and immune modulation. Deficiency has been linked to several autoimmune and inflammatory conditions, including rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SpA) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Beyond its calcemic effects, vitamin D regulates antigen-presenting cells, reduces expression of pro-inflammatory cytokines such as IL-6, IL-17, and TNF-α, and promotes tolerogenic immune responses (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eParathyroid hormone (PTH) regulates calcium and vitamin D metabolism. Previous studies have suggested that unsuppressed parathyroid hormone levels may occur in patients with autoimmune and inflammatory rheumatic diseases, with implications for vitamin D supplementation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Although hyperparathyroidism has been described in some patients with autoimmune conditions, its direct association with systemic inflammatory activity remains unclear (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eGlucocorticoids, although commonly used to control inflammation, accelerate vitamin D metabolism and may contribute to bone loss (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Considering these mechanisms, this study aimed to assess the prevalence of vitamin D deficiency and parathyroid dysfunction in IMRD and to explore their correlation with disease activity indices (DAS28 for RA, SLEDAI for SLE, and ASDAS for SpA).\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e We analyzed 40 consecutive patients\u0026thinsp;\u0026ge;\u0026thinsp;18 years old followed at the Rheumatology Outpatient Clinic of a tertiary hospital. Patients were randomly selected from RA, SLE, and SpA clinics. Serum vitamin D, PTH, and CRP were retrieved from records, along with disease activity indices (DAS28, SLEDAI, ASDAS). Three most recent results were considered, and the latest value was used. Glucocorticoid use was documented (yes/no, dose).\u003c/p\u003e\u003cp\u003eStatistical analysis: quantitative variables were tested for normality (Kolmogorov\u0026ndash;Smirnov). Means\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or medians were reported. Comparisons between groups used t-test or Kruskal\u0026ndash;Wallis. Spearman\u0026rsquo;s rho was applied for correlations (α\u0026thinsp;=\u0026thinsp;0.05). Analyses were performed using SPSS 25.0.\u003c/p\u003e\u003cp\u003e Ethical aspects: The study complied with the Declaration of Helsinki and was approved by the local Research Ethics Committee (CEP-UFTM).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAmong the 40 patients analyzed (RA=~20, SLE=~12, SpA=~8), vitamin D levels were below the recommended 30 ng/mL in most patients. RA patients had mean vitamin D ≈38 ng/mL, SLE ≈34 ng/mL, SpA ≈39 ng/mL. PTH values varied widely without consistent patterns. Activity scores averaged 2.5–3.0 across groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 shows mean values of vitamin D, PTH, and disease activity indices (DAS28, SLEDAI, ASDAS) for RA, SLE, and SpA.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur results confirm a high prevalence of vitamin D deficiency across IMRD. Although a weak inverse association with disease activity was observed, this correlation was not strong enough to suggest a direct causal role. This is consistent with previous observational studies.\u003c/p\u003e\u003cp\u003ePTH levels did not correlate with disease activity, indicating that parathyroid dysfunction may not drive systemic inflammation. Nonetheless, secondary hyperparathyroidism due to chronic vitamin D deficiency may contribute to long-term skeletal complications.\u003c/p\u003e\u003cp\u003eGlucocorticoid use was associated with higher activity scores, reflecting that patients with severe inflammation are more frequently treated. However, long-term glucocorticoid therapy may worsen bone metabolism and vitamin D homeostasis, reinforcing the need for careful monitoring.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eVitamin D deficiency is highly prevalent in IMRD patients and may play a role in disease modulation. PTH did not correlate with inflammatory activity, whereas glucocorticoid use was linked with more severe cases. Further longitudinal studies are needed to clarify whether vitamin D supplementation improves outcomes in RA, SLE, and SpA.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConsent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the principles of the Declaration of Helsinki. Given that data collection relied exclusively on medical records, the requirement for individual informed consent was waived by the Research Ethics Committee (CEP-UFTM), in accordance with CNS Resolution 466/2012.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLFH conducted the research, collected and analyzed the data, and wrote the manuscript. GSK supervised the project, provided guidance throughout the study, and critically reviewed the manuscript. Both authors approved the final version of the manuscript\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Research Ethics Committee of the Universidade Federal do Tri\u0026acirc;ngulo Mineiro (CEP-UFTM), under protocol number CAAE: 80804724.0.0000.8667.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSainaghi PP, Bellan M, Antonini G, Bellomo G, Pirisi M. Unsuppressed parathyroid hormone in patients with autoimmune/inflammatory rheumatic diseases. Rheumatology., Alejandro-Posso V, Medell\u0026iacute;n J, Kaimoto C, Ca\u0026ntilde;as M, Tobo CA. GJ. Rheumatological diseases in patients with primary hyperparathyroidism. Rheumatology. 2022. 3. G\u0026uuml;neş E, G\u0026uuml;neş M. Increased prevalence of autoimmune rheumatologic diseases in patients with primary hyperparathyroidism. Cureus. 2023. 4. Charoenngam N. Vitamin D and rheumatic diseases: a review of clinical evidence. Int J Mol Sci. 2021;22:10659.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEthics Approval The study protocol was reviewed and approved by the Research Ethics Committee of the. Universidade Federal do Tri\u0026acirc;ngulo Mineiro (CEP-UFTM), under protocol number CAAE: 80804724.0.0000.8667.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eConsent to Participate. This study was conducted in accordance with the principles of the Declaration of Helsinki. Given that data collection relied exclusively on medical records, the requirement for individual informed consent was waived by the Research Ethics Committee (CEP-UFTM), in accordance with CNS Resolution 466/2012.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFunding This research. received no specific grant from any funding agency, commercial, or not-for-profit sectors.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"
[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Vitamin D deficiency, Parathyroid hormone, Rheumatoid arthritis, Systemic lupus erythematosus, Spondyloarthritis, Disease activity","lastPublishedDoi":"10.21203/rs.3.rs-7745779/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7745779/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVitamin D deficiency and parathyroid dysfunction may play a role in immune-mediated rheumatic diseases (IMRD). This study aimed to investigate their prevalence, their relationship with disease activity, and the impact of glucocorticoid use.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eWe conducted a cross-sectional and longitudinal study including 40 adult patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SpA). Serum 25(OH)D (vitamin D), parathyroid hormone (PTH), and C-reactive protein (CRP) were measured, along with disease activity indices: DAS28 for RA, SLEDAI for SLE, and ASDAS for SpA. Correlations were tested using Spearman\u0026rsquo;s rho, with p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 considered statistically significant.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e\u003cp\u003eMean serum vitamin D levels were reduced across all groups (RA\u0026thinsp;\u0026asymp;\u0026thinsp;38 ng/mL, SLE\u0026thinsp;\u0026asymp;\u0026thinsp;34 ng/mL, SpA\u0026thinsp;\u0026asymp;\u0026thinsp;39 ng/mL). Vitamin D showed a weak negative correlation with disease activity. PTH values fluctuated but showed no clear correlation. Glucocorticoid use correlated with higher activity scores, reflecting clinical practice. Figure\u0026nbsp;1 illustrates vitamin D, PTH, and activity scores by disease group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e\u003cp\u003eVitamin D deficiency is prevalent in IMRD and may contribute to increased inflammatory activity, although associations are weak. Parathyroid dysfunction did not show a consistent link with disease activity. Glucocorticoid use was associated with more severe cases. Further longitudinal studies are warranted to clarify the impact of vitamin D supplementation and the long-term metabolic consequences of glucocorticoids in IMRD.\u003c/p\u003e","manuscriptTitle":"Prevalence of Parathyroid Disorders and Vitamin D Deficiency in Patients with IMRD","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-26 13:26:25","doi":"10.21203/rs.3.rs-7745779/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"
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