ArticleClinical rheumatology2026
Association between patterns of circulating vitamin co-exposure and the prognosis of rheumatoid arthritis.
Article in Clinical rheumatology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to examine the independent and joint associations of seven serum vitamins (vitamin A, B
methodsWe analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2003-2006 cycles, linked to National Death Index (NDI) mortality records through December 31, 2019. Of 37,866 total participants, we included 14,487 adults aged ≥ 20 years who were non-pregnant and had complete interview and laboratory examination. This analytic sample comprised 682 RA cases (defined by affirmative responses to both MCQ160A and MCQ190), 1191 osteoarthritis (OA) patients, and 12,614 healthy controls (HC). Missing vitamin concentrations (6.1-7.1% across analytes) were handled via multiple imputation using the Multivariate Imputation by Chained Equations (MICE) algorithm (m = 5). To assess joint associations with prevalent RA, we applied survey-weighted logistic regression, weighted quantile sum (WQS) regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (qgcomp). For survival analysis, Cox proportional hazards models were used to estimate hazard ratios (HRs) for all-cause mortality among RA patients, with DMARD and glucocorticoid use incorporated as time-varying covariates based on prescription history.
resultsAfter full covariate and medication adjustment and application of NHANES sampling weights, no individual vitamin was significantly associated with prevalent RA risk. Similarly, neither the WQS index (OR [95% CI] = 1.032 [0.976-1.090], p = 0.262) nor the qgcomp joint effect estimate (OR [95% CI] = 1.033 [0.906-1.177], p = 0.626) reached statistical significance. In longitudinal analysis (median follow-up: 14.0 years), higher circulating levels of vitamin C (HR [95% CI] = 0.627 [0.473-0.831], p = 0.001), vitamin B
conclusionsNeither individual vitamins nor their complex mixtures showed statistically significant associations with prevalent RA after accounting for confounding, survey design, and pharmacologic treatment. In contrast, higher serum concentrations of vitamins C, D, B
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