The role of vitamin D in multisystem sarcoidosis / Uloga vitamina D u sarkoidozi

Abstract

Summary: Recently published data indicate that vitamin D abnormalities are common in sarcoidosis patients. The purpose of this study was to compare serum vitamin 25(OH)D levels among sarcoidosis patients with different clinical courses of the disease. The study also included the first observations on cognitive functions (i.e. depression and fatigue syndrome) in relation to vitamin D deficiency in sarcoidosis patients. At the Biochemical Laboratory of the Clinical Center of Serbia, Belgrade, vitamin D25(OH)D was measured using the Elecsys ® Vitamin D total test. A total of 226 patients with biopsy-positive sarcoidosis were analyzed. The average median value of serum vitamin D was 9.47 mg/L, suggesting severe deficiency. Statistically significant correlation was found in patients with chronic disease and low levels of serum vitamin 25(OH)D (Chi-Square=6.044; df=2; p=0.014). The patient group with vitamin D serum levels higher than 20 mg/L showed higher levels of the mean forced vi tal capacity (FVC) by 380 mL, and forced expiratory volume in one second (FEV1) by 220 mL, when compared to the patient group with lower serum vitamin D. A statistically significant role was established for serum vitamin 25(OH)D levels as the predictor of fatigue (R 2 =0.878; p=0.038 (b=0.216)) and depression in patients with sarcoidosis (R 2 =0.80; p=0.000 (b=0.391)). The insufficiency of 25(OH)D seems to be an important factor in predicting the course of chronic disease, significant lung function impairments and cognitive failures such as fatigue and depression. The fact that the majo rity of the analyzed sarcoidosis patients had totally deficient serum 25(OH)D levels made this finding even more notable. Keywords: vitamin D, deficiency, sarcoidosisKratak sadr`aj: Nedavno objavljena istra`ivanja kod obole lih od sarkoidoze govore o ~estim abnormalnim vrednostima vitamina D. Cilj ove studije bio je da se uporedi nivo vita mina 25(OH)D kod obolelih od sarkoidoze sa razli~itim klini~kim tokom bolesti. Tako|e, ova studija predstavlja prva za pa `anja o vezi izme|u kognitivnih funkcija (odnosno ose}a ja depresije i zamora) i deficita vitamina D kod obolelih od sarko idoze. U Biohemijskoj laboratoriji Klini~kog centra Srbije vitamin D -25(OH)D meren je kori{}enjem testa Elec sys ® Vitamin D. Analizirano je 226 bolesnika sa sarkoidozom potvr|enom biopsijom. Prose~na srednja vrednost vitamina D u serumu bila je 9,47 mg/L, {to ukazuje na ozbiljan nedostatak. Statisti~ki zna~ajna korelacija na |e na je kod pa cije nata sa hroni~nom formom bolesti i niskim nivoom vitamina 25(OH)D u serumu (Xi-kvad rat=6,044; df=2; p=0,014). Grupa pacijenata sa nivoom vitamina D u serumu ve}im od 20 mg/L pokazuje ve}i nivo srednjeg for siranog vitalnog kapaciteta (FVC) za 380 mL i forsiranog ekspi ratornog volumena u prvoj sekundi (FEV1) za 220 mL u od nosu na grupu pacijenata sa ni`im nivoom D vitamina. Utvr|eno je da nivo vitamina 25(OH)D u serumu ima stati sti~ki zna~ajnu ulogu kao prediktor zamora i depresije kod obolelih od sarkoidoze. Insuficijencija 25(OH)D ...

Association Between Vitamin D Deficiencies in Sarcoidosis with Disease Activity, Course of Disease and Stages of Lung Involvements

“…Negative association was reported between 25-hydroxy vitamin D, active sarcoidosis, sarcoidosis chronicity and pulmonary function status in sarcoidosis patients, in recent studies (1, 4, 5, 18). But, correlation of 25-(OH)D status with sarcoidosis factors has not been yet studied in Iranian sarcoidosis population.…”

“…Ever since the first study was tested on the relationship between chronic respiratory diseases and vitamin D as a regulatory factor, many studies were conducted worldwide on this issue (23). But, the association of vitamin D deficiency with different features of sarcoidosis is not still well-studied (1). The purpose of this study was to investigate the relation between vitamin 25(OH)D serum level with Course of sarcoidosis, Status of Pulmonary function, Skin extra-pulmonary involvement, Lung involvement stage and Disease activity among sarcoidosis cases of Iran.…”

“…Sarcoidosis is a multi-organization disease characterized by granuloma formation and enhanced immune operation activities (1, 2). Several studies have advocated that the innate immune failure in responding to persistent antigens causes Granuloma formation of sarcoidosis (1, 2, 3). Sarcoidosis disease occurs in winter and in regions with increased latitude in which lack of sun-exposure leads to vitamin D deficiency (4, 5).…”

“…Overproduction of active form of vitamin D3 (calcitriol or 1,25-dihydroxy vitamin D (1,25(OH)2D)), provides hypercalcemia, hypercalciuria and osteoarticular manifestations (9, 10, 11, 12). In addition, hyperparathyroidism can cause hypercalcemia (1). In such cases although vitamin D serum level deficiency insists, but 1,25(OH)2D normal serum level remains a prime obstacle in efficiency of 1,25(OH)2D evaluation (10, 13, 14).…”

“…But, these patients represent low levels of 25-(OH)D (15, 16). As a result, measuring Vitamin D-25 as the major circulating form of vitamin D is the most efficient administrator to test the adequacy of vitamin D level (1, 17).…”