These vitamin supplements regulate painful inflammation in rheumatoid arthritis

Rheumatoid arthritis is characterized by chronic inflammation that attacks and destroys the joints. It also increases the risk of cardiovascular diseases, respiratory diseases, and premature death. However, according to a review article published in Clinical Rheumatology, supplements of vitamins D, B12, C, and K2 may play a crucial role in regulating inflammation, supporting bone health, improving circulation, and enhancing overall patient health.

Rheumatoid arthritis is an autoimmune disease in which multiple joints are affected by an inflammatory condition, leading to the destruction of cartilage. The surrounding joint capsule and bone may also become damaged and deformed.
Rheumatoid arthritis often begins gradually with increasing symptoms, and medical treatment is associated with serious side effects. The disease also raises the risk of cardiovascular diseases, and patients have twice the risk of heart attacks and premature death compared to the general population. This increased cardiovascular risk is partly due to chronic inflammation, which is characterized by oxidative stress, where free radicals attack cholesterol, an essential compound. As a result, the cholesterol oxidizes, becomes unusable for various bodily functions, and is deposited in artery walls where it promotes atherosclerosis.
Additionally, 30–40% of rheumatoid arthritis patients die from respiratory diseases, indicating that chronic inflammation contributes to multiple comorbidities.
It is well known that genetic factors, infections, toxins, smoking, and hormonal factors can trigger the disease. Diet also plays a significant role, and in this new review article, the authors have examined the effects of various vitamins, as detailed below:

Vitamin D

Vitamin D, considered a steroid hormone, regulates about 10% of genetic activity through on-and-off mechanisms. Vitamin D deficiency is common among rheumatoid arthritis patients and is linked to disease progression. This is partly because vitamin D is essential for the immune system to quickly and effectively combat pathogens and then regulate inflammatory processes in time. Supplementing with vitamin D has been shown to improve disease severity markers and reduce inflammation indicators in rheumatoid arthritis patients.
Another study, published in Nutrients, also found that arthritis patients treated with methotrexate had lower mortality rates if they had high blood levels of vitamin D.
Notably, official recommendations for vitamin D intake are relatively low. Some studies suggest that most people need 50 micrograms per day to optimize blood levels, a level that should ideally lie in the range between 100–150 nmol/L. However, individual needs may vary, and according to the European Food Safety Authority (EFSA), the upper safe limit is 100 micrograms per day.

Vitamin B12

Vitamin B12 is essential for blood formation, energy levels, and the immune system. Studies have shown that B12 deficiency can worsen fatigue in rheumatoid arthritis patients. Since vitamin B12 is only found in animal-based foods, vegetarians and especially vegans are at risk of deficiency. Aging, lack of stomach acid, antacid medications, and the diabetes drug metformin also increase the risk of B12 deficiency.
Deficiencies can be prevented or treated through dietary changes and supplementation. Many people benefit most from B12 in lozenge form, which allows better absorption through the mouth’s mucous membrane. Severe deficiencies and the autoimmune condition pernicious anemia require injections.

Vitamin C

Vitamin C is essential for collagen production, and a lack of collagen in the joints can weaken cartilage. Vitamin C is also crucial for the immune system, circulation, and as a powerful antioxidant. Studies suggest that vitamin C can counteract or reduce oxidative damage in the joints caused by free radicals. Additionally, vitamin C helps reduce chronic joint inflammation, which is linked to oxidative stress.
Good sources of vitamin C include citrus fruits, berries, vegetables like red bell peppers, cabbage, and spinach, as well as herbs such as garlic and ginger.
The recommended intake (RI) is set at 80 mg, but physical and mental stress, along with sugar and stimulant consumption, increases the body’s need for vitamin C. There are high-dose supplements available, and acid-neutral vitamin C sources are recommended to protect the stomach.

Vitamin K2

Vitamin K2 plays a role in both cardiovascular and bone health. First, it is involved in producing the protein MGP (Matrix Gla-Protein), which removes calcium from the bloodstream, helping to prevent atherosclerosis. Second, K2 is necessary for producing the protein osteocalcin, which helps incorporate calcium into bones, thereby preventing osteoporosis. By regulating calcium distribution in the body, K2 may also prevent joint calcification—a condition that can cause painful flare-ups and, in some cases, joint stiffness.
Studies have shown that K2 supplementation in rheumatoid arthritis patients can reduce inflammation and disease activity.
Vitamin K2 is found in egg yolks and meat from grass-fed animals, as well as in fermented foods like sauerkraut, kefir, and cheese.
Additionally, a well-functioning gut microbiome can convert vitamin K1 (found in dark leafy greens such as cabbage, parsley, spinach, and beans) into K2.
The recommended intake (RI) for vitamin K1 is set at 75 micrograms, but there is no established RI for K2.
K2 supplements typically contain 75–200 micrograms of the nutrient. However, the most important factor is choosing a high-quality product with good bioavailability.

Anti-Inflammatory Diet and Additional Information

To prevent and manage rheumatoid arthritis, adopting an anti-inflammatory diet can be beneficial. It is also important to be aware that gluten sensitivity can trigger autoimmune diseases like rheumatoid arthritis. Additionally, ensuring adequate intake of the omega-3 fatty acids EPA and DHA from fatty fish or fish oil supplements may be beneficial, as discussed further in this article.

»Omega-3 fatty acids help relieve rheumatic pain but only if you get enough«

Reference:

Nawai Hiijjawi et al. The role of vitamins D, B12, C, and K in modulating inflammation and disease management in rheumatoid arthritis: a Comprehensive review. Clinical Rheumatology 2024 Dec.

Shahdi K Malakooti et al. Higher Vitamin D Levels before Methotrexate Therapy Initiation Are Associated with Lower Subsequent Mortality in Patients With Rheumatoid Arthritis. Nutrients 2024

William B. Grant et al. A Narrative Review of the Evidence for Variations in Serum 25-Hydroxyvitamin D Concentration Thresholds for Optimal Health. Nutrients 2022

Jon Johnson. What is the link between gluten and rheumatoid arthritis? MedicalNewsToday 2023