The Clinical Significance of Vitamin D in Systemic Lupus Erythematosus: A Systematic Review

Abstract

BackgroundVitamin D deficiency is more prevalent among SLE patients than the general population. Over the past decade, many studies across the globe have been carried out to investigate the role of vitamin D in SLE from various clinical angles. Therefore, the aim of this systematic review is to summarise and evaluate the evidence from the published literature; focusing on the clinical significance of vitamin D in SLE.MethodsThe following databases were searched: MEDLINE, Scopus, Web of Knowledge and CINAHL, using the terms “lupus”, “systemic lupus erythematosus”, “SLE and “vitamin D”. We included only adult human studies published in the English language between 2000 and 2012.The reference lists of included studies were thoroughly reviewed in search for other relevant studies.ResultsA total of 22 studies met the selection criteria. The majority of the studies were observational (95.5%) and cross sectional (90.9%). Out of the 15 studies which looked into the association between vitamin D and SLE disease activity, 10 studies (including the 3 largest studies in this series) revealed a statistically significant inverse relationship. For disease damage, on the other hand, 5 out of 6 studies failed to demonstrate any association with vitamin D levels. Cardiovascular risk factors such as insulin resistance, hypertension and hypercholesterolaemia were related to vitamin D deficiency, according to 3 of the studies.ConclusionThere is convincing evidence to support the association between vitamin D levels and SLE disease activity. There is paucity of data in other clinical aspects to make firm conclusions.

25-Hydroxivitamin D Serum Concentration, Not Free and Bioavailable Vitamin D, Is Associated with Disease Activity in Systemic Lupus Erythematosus Patients

“…One possible explanation for the association between SLE and vitamin D deficiency is the universal recommendation that these patients should avoid sunlight exposure [7]. Moreover, many drugs used in SLE management, such as glucocorticoids and hydroxychloroquine, may interfere with vitamin D metabolism and 25-hidroxyvitamin D (25(OH)D) serum levels [8]. It has also been suggested that vitamin D deficiency might be a risk factor for the development of the disease, although vitamin D intake was not associated with the risk of SLE development in a prospective study [9].…”

Can oral vitamin D prevent the cardiovascular diseases among migrants in Australia? Provider perspective using Markov modelling

“…Therefore, it is worth considering subsidisation of oral vitamin D (vitamin D 3 , 1000 IU as a maintenance daily dose) in this high risk population group. Such a strategy will invariably improve the drug compliance, potentially reduce the non‐fatal and fatal cardiovascular outcomes also have the potential to deliver other skeletal and non‐skeletal benefits …”

“…Such a strategy will invariably improve the drug compliance, potentially reduce the non-fatal and fatal cardiovascular outcomes also have the potential to deliver other skeletal 18,19 and non-skeletal benefits. [20][21][22] Individuals with moderate or severe VDD are recommended to take higher doses (3000-5000 IU/day) of vitamin D under medical supervision for 6-12 weeks until the repletion of body stores and then can follow the daily maintenance dose. 14 There is some suggestion that with universal vitamin D supplementation the frequency of vitamin D testing could be eased, and thereby the mounting costs associated with vitamin D testing could be curtailed.…”

Recent Advances in Systemic Scleroderma in Childhood

“…Low levels of vitamin D are also present in the healthy population; therefore, it is difficult to evaluate the clinical significance of the high prevalence of vitamin D deficiency in patients with autoimmune diseases, which has been confirmed by several cross-sectional studies. Very low levels of vitamin D (< 10 ng/mL) are associated with certain symptoms and correlate with disease activity in SLE [99][100][101]. Several factors can influence the level of vitamin D in patients with scleroderma, as skin fibrosis can be altered with sun exposure and gut involvement can lead to malabsorption.…”