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Calcium Disorders in Rheumatic Diseases: An Overlooked Problem With Major Clinical Implications
Balakrishnan Navaneethakrishnan1, Gopalakrishnan Syamala Nikhila2
1Department of Rheumatology, Avinash Hospitals, Chennai, IND.
Insights
Calcium homeostasis is crucial for rheumatic diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), impacting skeletal integrity and immune function. Recognizing and managing calcium disorders can significantly improve patient outcomes in rheumatology.
Area of Science:
- Rheumatology
- Endocrinology
- Mineral Metabolism
Background:
- Calcium homeostasis is vital for skeletal integrity, immune signaling, and overall function in rheumatic diseases.
- Its importance is often underestimated, overshadowed by inflammatory processes in conditions like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
- Limited integration of calcium assessment into routine rheumatology care highlights a significant clinical gap.
Purpose of the Study:
- To synthesize current knowledge on the spectrum, mechanisms, manifestations, and management of calcium disorders in rheumatic diseases.
- To emphasize the underappreciated relevance of calcium balance in rheumatologic conditions and therapies.
- To advocate for the integration of calcium assessment into standard rheumatology practice.
Main Methods:
- A narrative review of literature published between 2015 and 2025.
- Searches were conducted using PubMed, Scopus, and Web of Science databases.
- Included original studies and review articles focusing on calcium disorders in rheumatic diseases.
Main Results:
- Chronic inflammation, therapies (e.g., disease-modifying antirheumatic drugs), endocrine disruption, and renal issues contribute to calcium imbalances (hypocalcemia, hypercalcemia, secondary hyperparathyroidism).
- These abnormalities are linked to increased skeletal fragility, renal complications, cardiovascular calcification, and diagnostic challenges.
- Calcium disorders are integral to rheumatic disease pathology, not merely incidental comorbidities.
Conclusions:
- Integrating calcium assessment into rheumatologic practice is essential for risk stratification and personalized therapy.
- Systematic, multidisciplinary attention to calcium homeostasis can meaningfully improve patient outcomes in rheumatic diseases.
- Recognizing calcium disorders as core components of rheumatic disease biology is crucial for advancing patient care.
Abstract:
Rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), spondyloarthritis, calcium pyrophosphate deposition disease, and the therapies used to treat them, particularly disease-modifying antirheumatic drugs, exemplify clinical contexts where calcium homeostasis has underappreciated relevance. Calcium balance is central to skeletal integrity, immune signalling, and multisystem function in rheumatic diseases, yet it is frequently overshadowed by inflammatory priorities. Despite growing evidence linking calcium disorders to morbidity, integration into routine rheumatology care remains limited, representing a persistent clinical gap. The objective of this review is to synthesize current knowledge on the spectrum, mechanisms, manifestations, and management of calcium disorders in rheumatic diseases. A narrative review was conducted using PubMed, Scopus, and Web of Science, covering literature published between 2015 and 2025, including original studies and reviews. Chronic inflammation, therapeutic exposures, endocrine disruption, and renal involvement collectively drive hypocalcemia, hypercalcemia, secondary hyperparathyroidism, and crystal deposition disorders. These abnormalities contribute to skeletal fragility, renal complications, cardiovascular calcification, and diagnostic uncertainty. Integrating calcium assessment into rheumatologic practice has important implications for risk stratification, individualized therapy, and the prevention of long-term complications. Calcium disorders should be recognized as integral components of rheumatic disease biology rather than incidental comorbidities. The systematic, multidisciplinary integration of calcium homeostasis into rheumatology care can meaningfully improve patient outcomes.
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