Vitamin D deficiency in patients with active systemic lupus erythematosus

Borba, Victória Zeghbi Cochenski; Vieira, José Gilberto H.; Kasamatsu, Teresa S.; Radominski, Sebastião Cézar; Sato, Emília Inoue; Lazaretti-Castro, Marise

doi:10.1007/s00198-008-0676-1

Cited by 169 publications

(165 citation statements)

References 37 publications

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“…Thereafter, several studies were conducted to evaluate the association between serum vitamin D levels and SLE. These studies revealed a high prevalence of vitamin D insufficiency in patients with SLE [10,11,15,22]. A casecontrol study of 25(OH)D3 and 1,25(OH)2D3 in patients with SLE, patients with rheumatoid arthritis (RA), patients with osteoarthritis (OA), and controls revealed that the 25(OH)D3 levels in patients with SLE were significantly lower than in patients with OA and controls, but that there was no difference in 1,25(OH)2D3 levels [10].…”

Section: Discussionmentioning

confidence: 99%

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

et al. 2010

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Vitamin D is a pleiotrophic hormone with immunoregulatory properties. Low levels of vitamin D have been discovered in various autoimmune diseases. Here, we investigated serum vitamin D levels in Koreans with systemic lupus erythematosus (SLE) and examined whether levels correlate with disease activity of SLE. Blood samples were prospectively collected from patients with SLE (n = 104) and normal controls (NC, n = 49) during the spring from March to May 2008. The level of serum 25-hydroxyvitamin D (25(OH)D3) was measured by radioimmunoassay. The serum 25(OH)D3 levels of patients with SLE (42.49 ± 15.08 ng/ml) were significantly lower than NC (52.72 ± 15.19 ng/ml, P \ 0.001). Additionally, 17 patients with SLE (16.3%) had vitamin D insufficiency, while two NC had vitamin D insufficiency (4.1%). The risk of vitamin D insufficiency was 4.6-fold increased in SLE (P = 0.032). The serum 25(OH)D3 levels, adjusted with BMI, were positively correlated only with hemoglobin (b = 0.256, P = 0.018) and serum complement 3 (b = 0.365, P = 0.002). Serum vitamin D levels were lower, and vitamin D insufficiency was more common in Korean patients with SLE, however, our study demonstrated that vitamin D levels might not be a good marker of disease activity.

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Section: Discussionmentioning

confidence: 99%

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

et al. 2010

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“…In a study of 36 lupus patients (12 with high activity and 24 with minimal activity), the subgroup of patients with high activity had significantly lower vitamin D levels than the healthy controls. 10 To the best of our knowledge, there have been no controlled studies regarding this topic that have focused on children.…”

Section: Resultsmentioning

confidence: 99%

“…Although studies of 25-hydroxyvitamin D [25-(OH)D] levels and disease activity in patients with SLE have not had consistent results, most cross-sectional studies show an inverse relationship between the levels of vitamin D and disease activity. [6][7][8][9][10][11][12] Although the association between disease activity and serum levels of 25-(OH)D has been demonstrated in adults, considerably less is known about this relationship in children with SLE. The aims of this study were to evaluate the vitamin D status in pediatric patients with SLE and to examine whether there is an association between the serum levels of 25-(OH)D and disease activity in this autoimmune disease.…”

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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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“…The results showed an improvement in levels of fatigue, albeit, they did not identify an improvement in overall disease activity (16) . Over the past 15 years, and in particular in the last 5 years, research has reported that SLE patients have significantly lower vitamin D status than their healthy counterparts (12,(17)(18)(19)(20)(21) . Some have reported an association between vitamin D status and disease activity with lower vitamin D status contributing to greater disease activity (17)(18)(19)(20)(22)(23)(24)(25) .…”

mentioning

confidence: 99%

“…Over the past 15 years, and in particular in the last 5 years, research has reported that SLE patients have significantly lower vitamin D status than their healthy counterparts (12,(17)(18)(19)(20)(21) . Some have reported an association between vitamin D status and disease activity with lower vitamin D status contributing to greater disease activity (17)(18)(19)(20)(22)(23)(24)(25) . An association between vitamin D and fatigue has also been reported (16,26) ; however, not all studies have observed a relationship between vitamin D and indices of disease activity in SLE (27)(28)(29)(30) .…”

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confidence: 99%

An evaluation of vitamin D status in individuals with systemic lupus erythematosus

et al. 2011

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Systemic lupus erythematosus (SLE) is a multi-system inflammatory disease where genetic susceptibility coupled with largely undefined environmental factors is reported to underlie the aetiology of the disease. One such factor is low vitamin D status. The primary source of vitamin D is endogenous synthesis following exposure of the skin to UVB light. Photosensitivity, sunlight avoidance and the use of sun protection factor in combination with medications prescribed to treat the symptoms of the disease, puts SLE patients at increased risk of vitamin D deficiency. Decreased conversion of 25-hydroxyvitamin D to the metabolically active form, 1,25-dihydroxyvitamin D 3 , is possible, due to renal impairment common in SLE putting additional stress on vitamin D metabolism. The majority of studies have identified low 25-hydroxyvitamin D in SLE patients, albeit using varying cut-offs ( < 25 to < 80 nmol/l). Of these studies, fifteen have investigated a link between status and disease activity with conflicting results. Variation with disease activity index measures used alongside methodological limitations within the study design may partially explain these findings. This review discusses the importance of optimal vitamin D status in SLE, critically evaluates research carried out to date that has investigated vitamin D in SLE, and highlights the need for a well-designed observational study that controls for diet, medication use, dietary supplements, UV exposure and seasonality, that uses sensitive methods for measuring vitamin D status and disease activity in SLE to conclusively establish the role of vitamin D in SLE.

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Vitamin D deficiency in patients with active systemic lupus erythematosus

Abstract: SLE patients demonstrated changes in bone remodeling strongly related to disease activity. A high prevalence of 25OHD deficiency was observed in SLE patients, indicating the need for vitamin D replacement.

Cited by 169 publications

References 37 publications

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus

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

An evaluation of vitamin D status in individuals with systemic lupus erythematosus

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