Association between circulating 25‐hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta‐analysis

Abstract

Aim The indicators for measuring vitamin D are various, and 25‐hydroxyvitamin D (25(OH)D) is considered as the optimal indicator of total vitamin D levels. In this study, we aim to deeply explore the 25(OH)D status in systemic lupus erythematosus (SLE) patients, and evaluate its relation to SLE risk and disease severity. Methods Literature about 25(OH)D status and its associations with SLE were searched in Pubmed, Embase and Cochrane Library databases. Standardized mean difference (SMD), odds ratio (OR) and corresponding 95% confidence interval (95% CI) were illustrated by forest plots, and correlation coefficients (r) were combined by generic inverse variance method. Heterogeneity and publication bias were quantified by I‐squared (I2) test, funnel plot and Egger's test, respectively. Sensitivity analyses were further examined by leave‐one‐out method. Results Nineteen articles were included into our meta‐analysis. The overall results showed that compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in SLE patients (pooled SMD = −1.63, 95% CI: −2.51 to −0.76). Subgroup analysis revealed that compared with the healthy controls, SLE patients of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ≥ 10, Arab and European ethnicity, all 4 seasons, no vitamin D supplement, had significantly lower circulating 25(OH)D levels; no significant differences were observed in SLE patients of SLEDAI < 10, mixed ethnicity, spring, summer, vitamin D supplement, respectively; no matter the changes of age, disease duration, and the therapy of corticosteroid or immunosuppressive or neither, circulating 25(OH)D levels were significantly reduced in SLE patients. The deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease (not significantly), significantly decrease SLE risk, respectively (pooled OR = 4.37, 95% CI: 1.49 to 12.84; pooled OR = 0.52, 95% CI: 0.22 to 1.26; pooled OR = 0.31, 95% CI: 0.15 to 0.63). Circulating 25(OH)D levels were inversely associated with SLEDAI (pooled correlation coefficient = −0.50, 95% CI: −0.8278 to −0.1689). Conclusions Compared with healthy controls, 25(OH)D levels are significantly lower in SLE patients, which is influenced by disease activity, ethnicity, seasons and vitamin D supplement; no matter the change of age, diseases duration and therapy of corticosteroid or immunosuppressive or neither, 25(OH)D levels are significantly decreased in SLE patients; the deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease, and significantly decrease SLE risk, respectively; and 25(OH)D levels inversely correlate with SLEDAI.

Systemic Lupus Erythematosus (SLE) Therapy: The Old and the New

“…In the context of a holistic approach to lupus patients, there is an emerging body of evidence supporting the importance of correct lifestyle habits in the management of the disease, with particular attention to smoking cessation, physical activity and vitamin D supplementation [57]. According to the results of a recent meta-analysis, tobacco smoking, in addition to its well-known adverse effects, significantly reduces the effectiveness of HCQ and belimumab in cutaneous lesions and systemic manifestations.…”

“…Physical activity is emerging as pivotal in the reduction of cardiovascular risk and has also been shown to have positive effects on fatigue and mental health [59]. Vitamin D deficiency is common in patients with SLE, and a large body of evidence supports the negative impact of vitamin D deficiency on disease activity, fatigue and risk of thrombosis [57].…”

Vitamin D in Colombian patients with systemic lupus erythematosus and its correlation with disease activity

“…Guan et al. 31 conducted another systematic revision and meta-analysis with 19 studies. They discovered that compared with healthy controls, 25(OH)D levels were significantly reduced in SLE patients with SLEDAI ≥ 10, Arab and European ethnicity or no vitamin D supplement, but no significant difference was found in SLE patients with SLEDAI <10, assay method of chemiluminescent immunoassay and mixed ethnicity.…”

There are similarities between rheumatic disease with lung involvement and COVID-19 pneumonia

“…This is unlikely to be entirely explained by poverty, exposure or co-morbidity and may be contributed to by blood group [16]. The role of vitamin D deficiency has been investigated [17] as its deficiency increases the risk of many immunologically driven disorders [18], such as rheumatoid arthritis, where low vitamin D levels are associated with worse articular outcomes [19], the development of interstitial lung disease [20] and SLE [21]. There is increasing evidence that vitamin D deficiency may also be associated with an increase in both prevalence and severity of COVID-19 infection [22].…”