In this paper, Peter Smith and colleagues report that in rats, vitamin D deficiency leads to hyperinnervation in skeletal muscle and hypersensitivity, thus suggesting that normalization of vitamin D status might be a useful prophylactic for muscle pain.
It should be considered that vitamin D receptors have also been located within glial cells. It is plausible that vitamin D, inhibiting the synthesis of inducible nitric oxide synthase and increasing in astrocytes glutathione and levels of gamma-glutamyl peptidase (which is thought to participate in the scavenging of reactive oxygen species), may potenttially reduce Schwann cell inflammation. Moreover, vitamin D may also upregulate the gene expression of nerve growth factor, which is produced both in keratinocytes and Schwann cells.
Therefore, I strongly agree with Peter Smith and colleagues' suggestion that it should be wise to achieve euvitaminosis D in muskoloskeletal pain patients.
Reference:
Kiraly SJ, Kiraly MA, Hawe RD, Makhani N. Vitamin D as a neuroactive substance. review. Sci World J 2006;6:125–39.
A substantial proportion of patients presenting to outpatient medical clinics who have localized or generalized musculoskeletal pain are vitamin D deficient without any abnormalities in other laboratory tests (1). Serum calcium phosphate and alkaline phosphatase levels are usually within normal limits. Many of them also have polyarthralgia involving small or large upper or lower limb joints similar to early stages of rheumatoid arthritis and/or lupus erythematosus. Many vitamin D-deficient patients with nonspecific musculoskeletal pain respond to vitamin D treatment (unpublished data) after raising serum 25-hyroxyvitamin D concentration to 30 ng/ml or more. The chief clinical findings in these patients are bone pain and hyperesthesia of anterior tibia, sternum, and costal bones, as well as myalgia or generalized muscle pain without specific localization. Articular symptoms sometimes are more severe in the morning, and nocturnal skeletal pain can be equivalent to inflammatory pain.
The mechanisms of pain in these patients cannot be explained based on available clinical data. Information presented in a research article by Tague et al. provides data to elucidate the relationship between vitamin D deficiency and nonspecific musculoskeletal pain. Muscle hypersensitivity, as demonstrated in vitamin D-deficient rats, and hyperinnervation are helpful in explaining severe bone pain and hyperesthesia in some locations, particularly at the lower limb bones. These mechanisms, including musculoskeletal hypersensitivity as described by Tague et al., can explain localized pain that can be elicited even by light palpation.
However, it seems that other mechanisms such as periosteal reaction or inflammatory processes may have a contributing role in the development of joint manifestations in these patients. The presence of accompanying symptoms such as joint pain exacerbated by immobility, morning stiffness, and joint tenderness is suggestive of inflammatory processes.
There is a significant association between undifferentiated arthritis and vitamin D deficiency (2). In addition, we have found an association between vitamin D deficiency and early-stage knee osteoarthritis (3). Data reported by Tague et al. suggest a study in which the efficacy of vitamin D supplementation would be investigated in a placebo-controlled trial.
References:
1. Heidari B, Shokri Shirvani J, Firouzjahi A, Heidari P, Hajian-Tilaki K. Association between nonspecific skeletal pain and vitamin D deficiency.International Journal of Rheumatic Diseases 2010; 13: 340-346.
2. Heidari B, Hajian-Tilaki K, Heidari P. The status of serum vitamin D in patients with rheumatoid arthritis and undifferentiated inflammatory arthritis compared with controls. Rheumatol Int.
3. Heidari B, Heidari P, Hajian K. (2011) Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop.
Comments
Luca Mascitelli, Comando Brigata Alpina “Julia
In this paper, Peter Smith and colleagues report that in rats, vitamin D deficiency leads to hyperinnervation in skeletal muscle and hypersensitivity, thus suggesting that normalization of vitamin D status might be a useful prophylactic for muscle pain.
Behzad Heidari, Rhouhani Hospital
A substantial proportion of
A substantial proportion of patients presenting to outpatient medical clinics who have localized or generalized musculoskeletal pain are vitamin D deficient without any abnormalities in other laboratory tests (1). Serum calcium phosphate and alkaline phosphatase levels are usually within normal limits. Many of them also have polyarthralgia involving small or large upper or lower limb joints similar to early stages of rheumatoid arthritis and/or lupus erythematosus. Many vitamin D-deficient patients with nonspecific musculoskeletal pain respond to vitamin D treatment (unpublished data) after raising serum 25-hyroxyvitamin D concentration to 30 ng/ml or more. The chief clinical findings in these patients are bone pain and hyperesthesia of anterior tibia, sternum, and costal bones, as well as myalgia or generalized muscle pain without specific localization. Articular symptoms sometimes are more severe in the morning, and nocturnal skeletal pain can be equivalent to inflammatory pain.
The mechanisms of pain in these patients cannot be explained based on available clinical data. Information presented in a research article by Tague et al. provides data to elucidate the relationship between vitamin D deficiency and nonspecific musculoskeletal pain. Muscle hypersensitivity, as demonstrated in vitamin D-deficient rats, and hyperinnervation are helpful in explaining severe bone pain and hyperesthesia in some locations, particularly at the lower limb bones. These mechanisms, including musculoskeletal hypersensitivity as described by Tague et al., can explain localized pain that can be elicited even by light palpation.
However, it seems that other mechanisms such as periosteal reaction or inflammatory processes may have a contributing role in the development of joint manifestations in these patients. The presence of accompanying symptoms such as joint pain exacerbated by immobility, morning stiffness, and joint tenderness is suggestive of inflammatory processes.
There is a significant association between undifferentiated arthritis and vitamin D deficiency (2). In addition, we have found an association between vitamin D deficiency and early-stage knee osteoarthritis (3). Data reported by Tague et al. suggest a study in which the efficacy of vitamin D supplementation would be investigated in a placebo-controlled trial.
References:
1. Heidari B, Shokri Shirvani J, Firouzjahi A, Heidari P, Hajian-Tilaki K. Association between nonspecific skeletal pain and vitamin D deficiency.International Journal of Rheumatic Diseases 2010; 13: 340-346.
2. Heidari B, Hajian-Tilaki K, Heidari P. The status of serum vitamin D in patients with rheumatoid arthritis and undifferentiated inflammatory arthritis compared with controls. Rheumatol Int.
3. Heidari B, Heidari P, Hajian K. (2011) Association between serum vitamin D deficiency and knee osteoarthritis. Int Orthop.