The development of arthritis and antinuclear antibodies correlate with serum 25-hydroxyvitamin D levels in patients with leprosy

Ribeiro, Sandra Lúcia Euzébio; Pereira, Helena Lúcia Alves; Mangueira, Cristóvão Luis Pitangueiras; Ferreira, Carlos Ernesto Santos; Rosseto, Eliane Aparecida; Scheinberg, Morton

doi:10.1136/annrheumdis-2012-201485

Cited by 14 publications

(7 citation statements)

References 9 publications

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“…Low vitD levels are found in a wide range of the world population. In Brazil it has been observed in about 60 % of the adolescent population [ 26 ] and 80 % of the adults in the Amazon region [ 27 ]. This vitamin is important for the immune system.…”

Section: Resultsmentioning

confidence: 99%

Downregulation of PHEX in multibacillary leprosy patients: observational cross-sectional study

et al. 2015

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BackgroundPeripheral nerve injury and bone lesions, well known leprosy complications, lead to deformities and incapacities. The phosphate-regulating gene with homologies to endopeptidase on the X chromosome (PHEX) encodes a homonymous protein (PHEX) implicated in bone metabolism. PHEX/PHEX alterations may result in bone and cartilage lesions. PHEX expression is downregulated by intracellular Mycobacterium leprae (M. leprae) in cultures of human Schwann cells and osteoblasts. M. leprae in vivo effect on PHEX/PHEX is not known.MethodsCross-sectional observational study of 36 leprosy patients (22 lepromatous and 14 borderline-tuberculoid) and 20 healthy volunteers (HV). The following tests were performed: PHEX flow cytometric analysis on blood mononuclear cells, cytokine production in culture supernatant, 25-hydroxyvitamin D (OHvitD) serum levels and 99mTc-MDP three-phase bone scintigraphy, radiography of upper and lower extremities and blood and urine biochemistry.ResultsSignificantly lower PHEX expression levels were observed in lepromatous patients than in the other groups (χ2 = 16.554, p < 0.001 for lymphocytes and χ2 = 13.933, p = 0.001 for monocytes). Low levels of 25-(OHvitD) were observed in HV (median = 23.0 ng/mL) and BT patients (median = 27.5 ng/mL) and normal serum levels were found in LL patients (median = 38.6 ng/mL). Inflammatory cytokines, such as TNF, a PHEX transcription repressor, were lower after stimulation with M. leprae in peripheral blood mononuclear cells from lepromatous in comparison to BT patients and HV (χ2 = 10.820, p < 0.001).ConclusionDownregulation of PHEX may constitute an important early component of bone loss and joint damage in leprosy. The present results suggest a direct effect produced by M. leprae on the osteoarticular system that may use this mechanism.Electronic supplementary materialThe online version of this article (doi:10.1186/s12967-015-0651-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Downregulation of PHEX in multibacillary leprosy patients: observational cross-sectional study

et al. 2015

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“…4,24 Ribeiro et al recently reported the relationship between vitamin D deficiency and development of ANA, suggesting that vitamin D might be a pathogenic link for the emergence of auto-immunity in patients with leprosy. 25 Longer duration of illness, older age of patients, a history of recurrences, prednisolone and chloroquine treatment for erythema nodosum leprosum have been associated with an increased frequency of ANA. Most studies noted an increased prevalence of ANA in patients with MB leprosy, that seems independent of duration of antimicrobial treatment.…”

Section: Discussionmentioning

confidence: 99%

Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review

Horta-Baas

Hernández-Cabrera

Barile-Fabris

et al. 2015

Lupus

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Leprosy is an infectious chronic disease with a wide range of clinical and serological manifestations. We report a case of a woman presenting with a malar rash, painless oral ulcers, photosensitivity, arthritis, positive antinuclear antibodies test and leuko-lymphopenia. Our case illustrates an unusual presentation of leprosy initially diagnosed as systemic lupus erythematosus (SLE). After the confirmation of multibacillary leprosy and multidrug therapy recommended by the World Health Organization, a good clinical response was observed. Recognition of rheumatic manifestations in leprosy is important as they may be confused with SLE. A literature review is presented to encourage clinicians to consider leprosy as a differential diagnosis. Specifically in patients with unusual rheumatic manifestations and persistent skin lesions, and when neurological symptoms are present. Leprosy has not been eradicated, so misdiagnosis can be frequent. It is necessary to increase medical practitioner awareness in order start proper treatment.

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“…A prospective study by Santos-Antunes et al found an inverse relationship between vitamin D levels and ANA positivity in IBD patients [77]. The presence of ANA has also been shown to correlate with low serum vitamin D levels in patients with leprosy ( p < 0.001) [78]. Ritterhouse et al observed that ANA-positive healthy controls are significantly more likely to be deficient in vitamin D levels than ANA-negative healthy controls ( p = 0.011) [46].…”

Section: Reviewmentioning

confidence: 99%

Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature

2017

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The development of autoimmunity and/or autoimmune diseases is multifactorial. Vitamin D is one of the factors that might play a role. We postulated that both the presence of adjuvants and insufficient levels of vitamin D may result in the development of autoimmunity in patients with autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in relation to silicone implant incompatibility. We measured vitamin D levels in 135 patients with ASIA in relation to silicone implant incompatibility and related findings to the presence of autoantibodies that are commonly used to diagnose systemic autoimmune diseases. Furthermore, we systematically reviewed the literature regarding vitamin D deficiency as a risk factor for the development of autoantibodies. Vitamin D measurements were available for analysis in 131 of 135 patients with ASIA in relation to SIIS. Twenty-three patients (18%) tested positive for autoantibodies, from which 18 patients (78%) had either a vitamin D deficiency or insufficiency (median vitamin D level 60.5 mmol/L), whereas five patients (22%) had sufficient vitamin D levels. The risk to develop autoantibodies was significantly increased in vitamin D deficient and/or insufficient patients [RR 3.14; 95% CI, 1.24–7.95; p = 0.009]. Reviewed literature suggested an association between vitamin D levels and the presence and/or titer levels of autoantibodies in different autoimmune diseases. From our current study and from our review of the literature, we conclude that vitamin D deficiency is related to the presence of autoantibodies. Whether vitamin D supplementation results in a decrease of autoimmunity needs to be studied prospectively.

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The development of arthritis and antinuclear antibodies correlate with serum 25-hydroxyvitamin D levels in patients with leprosy

Cited by 14 publications

References 9 publications

Downregulation of PHEX in multibacillary leprosy patients: observational cross-sectional study

Downregulation of PHEX in multibacillary leprosy patients: observational cross-sectional study

Multibacillary leprosy mimicking systemic lupus erythematosus: case report and literature review

Vitamin D deficiency as a risk factor for the development of autoantibodies in patients with ASIA and silicone breast implants: a cohort study and review of the literature

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