Evidence that abnormally large seasonal declines in vitamin D status may trigger SLE flare in non-African Americans

Abstract

Cross-sectional studies have shown that low vitamin D (25-hydroxyvitamin D (25(OH)D)) is associated with increased systemic lupus erythematosus (SLE) activity. This study is the first to assess the temporal relationship between 25(OH)D levels and onset of SLE flare. This assessment was made possible because of the specimen bank and database of the Ohio SLE Study (OSS), a longitudinal study of frequently relapsing SLE that involved regular bimonthly patient follow-up. We identified for this study 82 flares from 46 patients that were separated by at least 8 months from previous flares. Serum 25(OH)D levels were measured at 4 and 2 months before flare, and at the time of flare (a flare interval). We found that for flares occurring during low daylight months (LDM, Oct-Mar), 25(OH)D levels were decreased at the time of flare, but only in non-African American (non-AA) patients (32% decrease at flare, compared to 4 months prior, p < 0.001). To control for seasonal effects, we also measured 25(OH)D levels in the LDM “no-flare” intervals, which were intervals that matched to the same calendar months of the patients’ LDM flare intervals, but that didn’t end in flare (n = 24). For these matches, a significant decrease occurred in 25(OH)D levels during the flare intervals (18.1% decrease, p < 0.001), but not during the matching no-flare intervals (6.2% decrease, p = 0.411). For flares occurring during high daylight months (HDM), 25(OH)D levels changed only in non-AA patients, increasing slightly (5.6%, p = 0.010). Analysis of flare rates for the entire OSS cohort (n = 201 flares) revealed a tendency for higher flare rates during LDM compared to HDM, but again only in non-AA patients (p = 0.060). Flare rates were lower during HDM for non-AA patients compared to AA patients (p = 0.028). In conclusion, in non-AA SLE patients, unusually large declines in 25(OH)D during LDM may be mechanistically related to SLE flare, whereas relatively high 25(OH)D levels during HDM may protect against flare.

Current Daily Glucocorticoid Use and Serum Creatinine Levels Are Associated With Lower 25(OH) Vitamin D Levels in Thai Patients With Systemic Lupus Erythematosus

“…7,9,14,16,38 In contrast, there were reports that lower serum 25(OH)D levels were associated with higher disease activity 10,15,17,22,23 and flares of lupus activity. 24,25 In our study, the disease activity and damage were generally low. We excluded patients who were hospitalized 1 month before their visits because it might limit the sun exposure and effect on serum 25(OH)D levels.…”

Juvenile onset systemic lupus erythematosus: a possible role for vitamin D in disease status and bone health

“…22 A recent study showed that seasonal declines in vitamin D levels may trigger flares in non-African American SLE patients. 51 Contrarily, four studies in adult lupus showed no association between vitamin D levels and lupus activity. [23][24][25][26] These controversial findings may be explained by the limited number of patients analyzed and differences in the severity of disease activity.…”

Relationship of Circulating Anti-C3b and Anti-C1q IgG to Lupus Nephritis and Its Flare

“…LN flares were documented on the basis of criteria for proteinuria, serum creatinine, and urine sediment ( Table 2) that closely parallel the current ACR criteria for LN flare, which we have previously detailed (3)(4)(5)(6). Proteinuria was quantified as protein-to-creatinine ratios from intended 24-hour urine collections.…”