Disease Activity, Proteinuria, and Vitamin D Status in Children with Systemic Lupus Erythematosus and Juvenile Dermatomyositis

Robinson, Angela Byun; Thierry-Palmer, Myrtle; Gibson, Keisha; Rabinovich, C. Egla

doi:10.1016/j.jpeds.2011.08.011

Cited by 68 publications

(65 citation statements)

References 34 publications

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“…Thus the immunomodulating effects of vitamin D may explain the reported epidemiological associations between vitamin D status and a large number of autoimmune and inflammatory diseases [100]. Several reviews [101,102] have shown a high prevalence of vitamin D deficiency in patients with SLE, showing evidence of antibodies to 1,25 (OH) 2 D, the biologically active form of vitamin D, which is rarely measured in clinical practice [103,104]. Mok et al have suggested that 25-(OH)D levels are as specific as antibodies to C1q complement factor (anti-C1q) for detecting concurrent renal activity in SLE and Wu et al [105] have correlated vitamin D levels with CV risk factors [106].…”

Section: Vitamin D Deficiencymentioning

confidence: 99%

Why are kids with lupus at an increased risk of cardiovascular disease?

2015

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Juvenile-onset systemic lupus erythematosus (SLE) is an aggressive multisystem autoimmune disease. Despite improvements in outcomes for adult patients, children with SLE continue to have a lower life expectancy than adults with SLE, with more aggressive disease, a higher incidence of lupus nephritis and there is an emerging awareness of their increased risk of cardiovascular disease (CVD). In this review, we discuss the evidence for an increased risk of CVD in SLE, its pathogenesis, and the clinical approach to its management.

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Section: Vitamin D Deficiencymentioning

confidence: 99%

Why are kids with lupus at an increased risk of cardiovascular disease?

2015

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“…They also found no association between disease activity and serum 25-(OH)D levels, which could be explained the fact that the tool they used to measure disease activity was based only on the attending physician's assessment. Moreover, Robinson et al 20 found that vitamin D levels were lower in patients with SLE who had proteinuria than in those who did not have this condition (11.9 and 25.0 ng/ml, respectively). Moreover, they also determined that vitamin D levels were associated with disease activity.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D Levels and Disease Activity in Children with Systemic Lupus Erythematosus

et al. 2014

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Objectives: This study aims to evaluate the association between vitamin D deficiency and disease activity in children with juvenile systemic lupus erythematosus (SLE). Patients and methods:A total of 16 children (13 girls and 3 boys; mean age 14.47 years; range 5-18) with SLE who were under followup in our clinic were included in this study. The medical records of the children along with the demographic data, disease duration, treatments received, disease activity, and 25-hydroxyvitamin D [25-(OH)D] levels were evaluated. Systemic lupus erythematosus disease activity (SLEDAI) scores were calculated on the day the serum samples were drawn. Results:The median follow-up period was 30 (range 9 to 55) months. The mean serum vitamin D level was 22.04±16.75 ng/ml. Vitamin D deficiency (serum vitamin D level of <15 ng/ml) was found in half of the patients. Six of them had significantly lower vitamin D levels (≤10 ng/ml). A significant negative correlation between the serum concentrations of vitamin D and the SLEDAI scores was found (r= -0.711, p=0.002). Conclusion:Our study results show that there is a strong negative association between disease activity and vitamin D deficiency in children with SLE. The vitamin D levels of these patients should be evaluated on a regular basis, and vitamin D supplements should be given, if necessary. Vitamin D is an essential steroid hormone that has a primary role in mineral metabolism, skeletal health, and the immune system.1 Since an epidemic of vitamin D deficiency has recently been recognized, many publications have revealed an association between vitamin D deficiency and several diseases with high morbidity and mortality.2 Although the precise etiologic mechanisms are unclear, it is becoming apparent that unrecognized vitamin D deficiency contributes to the increasing incidence and severity of many chronic health conditions. In addition, evidence is accumulating which suggests that vitamin D also plays a key part in the pathogenesis and progression of autoimmunity.1,3 Vitamin D receptors are found on several immune cells, and in vitro studies have shown that vitamin D metabolites modulate T cell proliferation and dendritic cell function by inhibiting the development of T helper 1 cells (Th1) and Th17 cells while promoting the growth of Th2 and T regulatory (Treg) cells. In B cells, vitamin D inhibits antibody secretion and autoantibody production, and vitamin D has the overall effect of immunosuppression.

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“…Al evaluar las concentraciones de vitamina D se encontró que los sujetos que usan bloqueador solar presentan concentraciones más bajas comparados con aquellos que no lo usan (p = 0.05). En el estudio realizado por Robinson y colaboradores, en el cual evaluaron a 37 sujetos de 4 a 21 años de edad con diagnóstico de LES, reportaron el uso de bloqueador solar en el 57%, que estuvo asociado con un incremento de 6 ng/ml en las concentraciones de 25(OH) D. Cabe mencionar que los usuarios de bloqueador solar fueron los sujetos con ingesta de suplementos de vitamina D, a diferencia de este estudio en el cual los sujetos no tomaron estos suplementos 37 . Se ha descrito en la literatura que el uso de esteroides puede contribuir de forma adversa con el metabolismo y la biodisponibilidad de la vitamina D 6,29 .…”

Section: Discussionunclassified