{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:52:37Z","timestamp":1789480357720,"version":"build-2803163510"},"reference-count":31,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"VA Merit funding","doi-asserted-by":"publisher","award":["CX001791"],"award-info":[{"award-number":["CX001791"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>(1) Vitamin D deficiency is associated with mortality in the general population and has been observed in one rheumatoid arthritis (RA) cohort. Here, we investigate the relationship between 25-hydroxyvitamin D (25(OH)D) levels before methotrexate (MTX) therapy initiation in patients with RA and the subsequent all-cause mortality in a national Veterans Affairs (VA) cohort. (2) This is a retrospective study on RA patients time-oriented around the initial MTX prescription and 25(OH)D levels before starting MTX. We examined survival in patients with 25(OH)D levels &gt; 50 nmol\/L and \u226450 nmol\/L using the Cox Proportional Hazard Model and fully adjusted for risk factors. (3) In total, 15,109 RA patients were included in the nationwide cohort. RA patients with 25(OH)D levels &gt; 50 nmol\/L before starting MTX had a 28% reduced risk of mortality when compared to those with levels \u2264 50 nmol\/L (HR: 0.72, CI: 0.64\u20130.80, p &lt; 0.001) after adjusting for traditional risk factors. (4) In this national RA cohort receiving standard-of-care MTX, patients with 25(OH)D levels &gt; 50 nmol\/L have a lower subsequent mortality when compared to those with 25(OH)D levels \u2264 50 nmol\/L. It remains to be determined whether increasing Vitamin D levels in RA patients initially found to be Vitamin D deficient impacts their all-cause mortality.<\/jats:p>","DOI":"10.3390\/nu16030401","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T07:49:47Z","timestamp":1706600987000},"page":"401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Higher Vitamin D Levels before Methotrexate Therapy Initiation Are Associated with Lower Subsequent Mortality in Patients with Rheumatoid Arthritis"],"prefix":"10.3390","volume":"16","author":[{"given":"Shahdi K.","family":"Malakooti","sequence":"first","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hinnah","family":"Siddiqui","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigid","family":"Wilson","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taissa","family":"Bej","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"O\u2019Mara","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Desotelle","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-4858","authenticated-orcid":false,"given":"Alyssa","family":"Lange","sequence":"additional","affiliation":[{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-1246","authenticated-orcid":false,"given":"Carey L.","family":"Shive","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora G.","family":"Singer","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace A.","family":"McComsey","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenche","family":"Kostadinova","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Mattar","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Zidar","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1226-5976","authenticated-orcid":false,"given":"Donald D.","family":"Anthony","sequence":"additional","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA"},{"name":"Department of Medicine, MetroHealth Medical Center, Cleveland, OH 44109, USA"},{"name":"Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.ecl.2017.07.001","article-title":"Biology and Mechanisms of Action of the Vitamin D Hormone","volume":"46","author":"Pike","year":"2017","journal-title":"Endocrinol. 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