Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis

Department of Medicine 'B' and Centre for Autoimmune Diseases, Sheba Medical Centre, (Affiliated to Tel-Aviv University) Tel-Hashomer 52621, Israel.
Annals of the rheumatic diseases (Impact Factor: 10.38). 06/2010; 69(6):1155-7. DOI: 10.1136/ard.2009.120329
Source: PubMed


Low serum vitamin D concentrations have been reported in several autoimmune disorders.
To assess whether low serum vitamin D concentrations are related to disease activity of patients with systemic lupus erythematosus (SLE).
378 patients from several European and Israeli cohorts were pooled and their disease activity was measured by two different methods: 278 patients had SLE disease activity-2000 (SLEDAI-2K) scores and 100 patients had European Consensus Lupus Activity Measurement (ECLAM) scores. In order to combine the two systems the scores were converted into standardised values (z-scores), enabling univariate summary statistics for the two variables (SLEDAI-2K and ECLAM). The commercial kit, LIAISON 25-OH vitamin D assay (310900-Diasorin) was used to measure serum concentration of 25-OH vitamin D in 378 patients with SLE.
A significant negative correlation was demonstrated between the serum concentration of vitamin D and the standardised values (z-scores) of disease activity scores as measured by the SLEDAI-2K and ECLAM scales (Pearson's correlation coefficient r=-0.12, p=0.018).
In a cohort of patients with SLE originating from Israel and Europe vitamin D serum concentrations were found to be inversely related to disease activity.

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    • "Vitamin D deficiency is often seen in patients with SLE (7-9). Wright et al. (12), when evaluating 38 individuals with JSLE, observed a high frequency of severe vitamin D deficiency (<10 ng/mL), with a significant difference compared to controls. "
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    ABSTRACT: We evaluated the concentrations of 25-hydroxyvitamin D [25(OH)D] in children and adolescents with juvenile systemic lupus erythematosus (JSLE) and associated them with disease duration and activity, use of medication (chloroquine and glucocorticoids), vitamin D intake, calcium and alkaline phosphatase levels, and bone mineral density. Thirty patients with JSLE were evaluated and compared to 30 healthy individuals, who were age and gender matched. Assessment was performed of clinical status, disease activity, anthropometry, laboratory markers, and bone mineral density. The 30 patients included 25 (83.3%) females and 16 (53.3%) Caucasians, with a mean age of 13.7 years. The mean age at diagnosis was 10.5 years and mean disease duration was 3.4 years. Mean levels of calcium, albumin, and alkaline phosphatase were significantly lower in patients with JSLE compared with controls (P<0.001, P=0.006, and P<0.001, respectively). Twenty-nine patients (97%) and 23 controls (77%) had 25(OH)D concentrations lower than 32 ng/mL, with significant differences between them (P<0.001). Fifteen patients (50%) had vitamin D levels <20 ng/mL and 14 had vitamin D levels between 20 and 32 ng/mL. However, these values were not associated with greater disease activity, higher levels of parathormone, medication intake, or bone mineral density. Vitamin D concentrations were similar with regard to ethnic group, body mass index, height for age, and pubertal stage. Significantly more frequently than in controls, we observed insufficient serum concentrations of 25(OH)D in patients with JSLE; however, we did not observe any association with disease activity, higher levels of parathormone, lower levels of alkaline phosphatase, use of medications, or bone mineral density alterations.
    Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas / Sociedade Brasileira de Biofisica ... [et al.] 07/2014; DOI:10.1590/1414-431X20143948 · 1.01 Impact Factor
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    • "These include the ecological findings of the prevalence of diseases, such as multiple sclerosis (MS), type 1 diabetes, inflammatory bowel disease, rheumatoid arthritis and Sjogren’s syndrome, positively correlating with latitude and reduced ultraviolet radiation exposure (the primary determinant of vitamin D levels) [1]. Further support comes from studies showing low serum vitamin D levels in patients suffering from a wide range of immune disorders, including MS [7], type 1 diabetes [8], systemic lupus erythematosus (SLE) [9] and rheumatoid arthritis [10]. These findings may, however, be biased by reverse causation [11]. "
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    ABSTRACT: Previous studies have suggested that there may be an association between vitamin D deficiency and the risk of developing immune-mediated diseases. We analyzed a database of linked statistical records of hospital admissions and death registrations for the whole of England (from 1999 to 2011). Rate ratios for immune-mediated disease were determined, comparing vitamin D deficient cohorts (individuals admitted for vitamin D deficiency or markers of vitamin D deficiency) with comparison cohorts. After hospital admission for either vitamin D deficiency, osteomalacia or rickets, there were significantly elevated rates of Addison's disease, ankylosing spondylitis, autoimmune hemolytic anemia, chronic active hepatitis, celiac disease, Crohn's disease, diabetes mellitus, pemphigoid, pernicious anemia, primary biliary cirrhosis, rheumatoid arthritis, Sjogren's syndrome, systemic lupus erythematosus, thyrotoxicosis, and significantly reduced risks for asthma and myxoedema. This study shows that patients with vitamin D deficiency may have an increased risk of developing some immune-mediated diseases, although we cannot rule out reverse causality or confounding. Further study of these associations is warranted and these data may aid further public health studies.
    BMC Medicine 07/2013; 11(1):171. DOI:10.1186/1741-7015-11-171 · 7.25 Impact Factor
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    • "Across the studies, the correlation between vitamin D levels and SLE disease activity has been rather inconsistent. Out of the 15 studies which looked into this aspect, two third of the studies (10/15) reported a significant inverse association between vitamin D and the measured disease activity [10], [14], [15], [16], [17], [18], [19], [20], [21], [22]. There were no significant methodological variations between the 10 studies showing an inverse relationship between vitamin D and the disease activity and the 5 studies that did not show such relationship. "
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    ABSTRACT: Vitamin 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. THE 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. A 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. There 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.
    PLoS ONE 01/2013; 8(1):e55275. DOI:10.1371/journal.pone.0055275 · 3.23 Impact Factor
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