Correlation between Vitamin-D and Calcium levels with severity of nail involvement in psoriasis: An observational study from Northern India

Abstract

Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints. Several studies have reported lower levels of vitamin D and calcium in psoriasis. But there is paucity of literature regarding levels of vitamin D and calcium in nail psoriasis. Objective: To study the level of Vitamin D and calcium in psoriasis patients with nail involvement and to correlate their levels with nail severity using Nail Psoriasis Severity Index (NAPSI). Materials and Methods: A total of 60 psoriasis patients with nail changes were recruited for the study. The severity of nail changes was calculated using Nail Psoriasis Severity Index (NAPSI). All non-specific nail changes which were present in the psoriasis patients were noted as well. Apart from routine investigations, blood calcium level and serum vitamin D levels were also sent for investigation. Results: Majority of the participants were male with male: female ratio of 2.75:1. The mean age at of onset of nail involvement was 42.87 ± 17.19 years. About three-fourth of the patients were hypocalcaemic and vitamin D deficient or insufficient. There was a moderate negative correlation between NAPSI and blood calcium (mg/dL), and it was statistically significant (rho = -0.33, P = 0.011). There was a weak positive correlation between NAPSI and S. Vitamin-D (ng/mL), and this correlation was not statistically significant (rho = 0.11, P = 0.402). However, on multivariate regression analysis of NAPSI, significant association was found between nail psoriasis severity index (NAPSI) with blood calcium level and serum vitamin D levels (P=0.01). Conclusion: Blood calcium and serum vitamin D levels were found low in patients of nail psoriasis. Hence, oral vitamin D and calcium supplementation may aid in the earlier response to standard nail psoriasis treatment and further studies are required to prove the therapeutic effect of calcium and vitamin D in nail psoriasis.

Efetividade Terapêutica Da Vitamina D Em Pacientes Com Psoríase: Uma Revisão Sistemática

“…Seguindo a mesma vertente, ponderou-se que níveis inapropriados de vitamina D foram associados com a perda da tolerância imunológica e, assim, podem favorecer o aparecimento da doença considerando seu viés imunológico, além dos estudos sugerirem uma relação entre 25 (OH) D e a gravidade da doença. Por outro lado, sua fisiopatologia se conserva não tão bem esclarecida, mas evidências apontam que a produção excessiva de citocinas e quimiocinas pelo sistema imune incita os queratinócitos que exprimem genes favorecendo um microambiente inflamatório e causando a psoríase (INGRAM et al, 2018;DISPHANURAT et al, 2019;KHARE;TRIVEDI, 2020). Dentre as associações mais utilizadas nos estudos, ressaltou-se o uso de corticoides com os análogos da vitamina D como terapia adjuvante, principalmente nos portadores de psoríase leve a moderada.…”