Startseite Vitamin D status and its relationship with systemic lupus erythematosus as a determinant and outcome of disease activity
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Vitamin D status and its relationship with systemic lupus erythematosus as a determinant and outcome of disease activity

  • Chayanika Dutta , Sanjeeb Kakati , Bhupen Barman EMAIL logo und Kaustubh Bora EMAIL logo
Veröffentlicht/Copyright: 3. April 2019
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Hormone Molecular Biology and Clinical Investigation
Aus der Zeitschrift Hormone Molecular Biology and Clinical Investigation Band 38 Heft 3

Abstract

Background

The importance of vitamin D (VD) in systemic lupus erythematosus (SLE) is being increasingly appreciated, with studies suggesting a relationship between VD deficiency and SLE onset/disease activity. We investigated VD status in SLE patients and its associations with disease activity in a geographical region of India receiving low solar ultraviolet-B (UV-B) index.

Materials and methods

We enrolled 109 SLE patients along with 109 healthy controls belonging to same ethnicity and localities. Demographic and clinico-laboratory information were recorded. VD status was assessed by estimating serum 25-hydroxyvitamin D (25-OH-D) concentrations (deficient: <20 ng/mL, insufficient: 21–29 ng/mL, and sufficient/normal: ≥30 ng/mL) using an enzyme-linked fluorescent assay (ELFA). The SLE Disease Activity Index (SLEDAI) scoring system was used to evaluate disease activity. The association between VD status and disease activity was assessed by univariate and multivariate approaches.

Results

Hypovitaminosis D was prevalent in 90.83% SLE patients [vs. 77.98% healthy controls; chi-squared (χ2) = 10.125, df = 2, p < 0.01]. SLEDAI scores and 25-OH-D values were inversely associated, which extended in a two-way manner as revealed by multiple logistic regression models. SLE patients with VD deficiency were more likely to have high/very high disease activity [adjusted odds ratio (OR) = 3.5, 95% confidence intervals (CI): 1.4–8.9]. Conversely, patients with high SLEDAI scores (>10) also had greater risks of being VD deficient (adjusted OR = 3.9, 95% CI: 1.5–10.8).

Conclusion

VD deficiency is widespread in SLE. The relationship appears to be bidirectional, with VD status associated both as determinant and outcome of disease activity in SLE.

Keywords: 25-hydroxyvitamin D; disease activity; risk factor; systemic lupus erythematosus; vitamin D deficiency

Author Statement

  1. Research funding: None.

  2. Conflict of interest: Authors state no conflicts of interest.

  3. Informed consent: Voluntary informed written consent was procured from all the participants of the study.

  4. Ethical approval: The research related to human use complied with all the relevant national regulations and institutional policies and was performed in accordance to the tenets of the Helsinki Declaration and has been approved by the institutional ethical committee.

  5. Authors’ contributions: SK and CD carried out the conceptualization. KB and BB contributed to the design and carried out the literature review. CD was involved in enrolment of study participants, and the collection of their clinico-laboratory information, under the supervision of SK. CD contributed to data management. KB analyzed and interpreted the data with inputs from BB. KB wrote the manuscript with inputs from CD. SK and BB helped in critically revising the manuscript. All authors accept responsibility of the manuscript.

References

[1] Lisnevskaia L, Murphy G, Isenberg D. Systemic lupus erythematosus. Lancet. 2014;384:1878–88.10.1016/S0140-6736(14)60128-8Suche in Google Scholar PubMed

[2] Kamen DL. Environmental influences on systemic lupus erythematosus expression. Rheum Dis Clin North Am. 2014;40:401–12.10.1016/j.rdc.2014.05.003Suche in Google Scholar PubMed PubMed Central

[3] Ramos PS, Brown EE, Kimberly RP, Langefeld CD. Genetic factors predisposing to systemic lupus erythematosus and lupus nephritis. Semin Nephrol. 2010;30:164–76.10.1016/j.semnephrol.2010.01.007Suche in Google Scholar PubMed PubMed Central

[4] Fernando MM, Isenberg DA. How to monitor SLE in routine clinical practice. Ann Rheum Dis. 2005;64:524–7.10.1136/ard.2003.015248Suche in Google Scholar PubMed PubMed Central

[5] Griffiths B, Mosca M, Gordon C. Assessment of patients with systemic lupus erythematosus and the use of lupus disease indices. Best Pract Res Clin Rheumatol. 2005;19:685–708.10.1016/j.berh.2005.03.010Suche in Google Scholar PubMed

[6] Gyori N, Giannakou I, Chatzidionysiou K, Magder L, van Vollenhoven RF, Petri M. Disease activity patterns over time in patients with SLE: analysis of the Hopkins Lupus Cohort. Lupus Sci Med. 2017;4:e000192.10.1136/lupus-2016-000192Suche in Google Scholar PubMed PubMed Central

[7] Adams JS, Hewison M. Unexpected actions of vitamin D: new perspectives on the regulation of innate and adaptive immunity. Nat Clin Pract Endocrinol Metab. 2008;4:80–90.10.1038/ncpendmet0716Suche in Google Scholar PubMed PubMed Central

[8] Szymczak I, Pawliczak R. The active metabolite of vitamin D3 as a potential immunomodulator. Scand J Immunol. 2016;83:83–91.10.1111/sji.12403Suche in Google Scholar PubMed

[9] Schneider L, Dos Santos AS, Santos M, da Silva Chakr RM, Monticielo OA. Vitamin D in systemic lupus erythematosus: state of the art. Clin Rheumatol. 2014;33:1033–8.10.1007/s10067-014-2530-5Suche in Google Scholar PubMed

[10] Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS. Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev. 2006;5:114–7.10.1016/j.autrev.2005.05.009Suche in Google Scholar PubMed

[11] Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C. Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and consequences. Rheumatology. 2008;47:920–3.10.1093/rheumatology/ken121Suche in Google Scholar PubMed

[12] Perracchi OA, Terreri MT, Munekata RV, Len CA, Lazaretti-Castro M, Hilario MO. Low serum concentrations of 25-hydroxyvitamin D in children and adolescents with systemic lupus erythematosus. Braz J Med Biol Res. 2014;47:721–6.10.1590/1414-431X20143948Suche in Google Scholar PubMed

[13] Sumethkul K, Boonyaratavej S, Kitumnuaypong T, Angthararuk S, Cheewasat P, Manadee N, et al. The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus. Rheumatol Int. 2013;33:1461–7.10.1007/s00296-012-2537-7Suche in Google Scholar PubMed

[14] Salman-Monte TC, Torrente-Segarra V, Almirall M, Corzo P, Mojal S, Carbonell-Abello J. Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region. Rheumatol Int. 2016;36:975–85.10.1007/s00296-016-3497-0Suche in Google Scholar PubMed

[15] Dall’Ara F, Andreoli L, Piva N, Piantoni S, Franceschini F, Tincani A. Winter lupus flares are associated with low vitamin D levels in a retrospective longitudinal study of Italian adult patients. Clin Exp Rheumatol. 2015;33:153–8.Suche in Google Scholar

[16] Hoffecker BM, Raffield LM, Kamen DL, Nowling TK. Systemic lupus erythematosus and vitamin D deficiency are associated with shorter telomere length among African Americans. PLoS One. 2013;8:e63725.10.1371/journal.pone.0063725Suche in Google Scholar PubMed PubMed Central

[17] Mandal M, Tripathy R, Panda AK, Pattanaik SS, Dakua S, Pradhan AK, et al. Vitamin D levels in Indian systemic lupus erythematosus patients: association with disease activity index and interferon alpha. Arthritis Res Ther. 2014;16:R49.10.1186/ar4479Suche in Google Scholar PubMed PubMed Central

[18] Schoindre Y, Jallouli M, Tanguy ML, Ghillani P, Galicier L, Aumaitre O, et al., on behalf of Group PLUS. Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up. Lupus Sci Med. 2014;1:e000027.10.1136/lupus-2014-000027Suche in Google Scholar PubMed PubMed Central

[19] Yap KS, Northcott M, Hoi ABY, Morand EF, Nikpour M. Association of low vitamin D with high disease activity in an Australian systemic lupus erythematosus cohort. Lupus Sci Med. 2015;2:e000064.10.1136/lupus-2014-000064Suche in Google Scholar PubMed PubMed Central

[20] Gao CC, Liu SY, Wu ZZ, Li TF, Gao GM, Liu ZS, et al. Severe vitamin D deficiency increases the risk for moderate to severe disease activity in patients with SLE. Lupus. 2016;25:1224–9.10.1177/0961203316635289Suche in Google Scholar PubMed

[21] Ding Y, Liao W, He XJ, Xiang W. Effects of 1,25(OH)2D3 and vitamin D receptor on peripheral CD4+/CD8+ double-positive T lymphocytes in a mouse model of systemic lupus erythematosus. J Cell Mol Med. 2017;21:975–85.10.1111/jcmm.13037Suche in Google Scholar PubMed PubMed Central

[22] Hassanalilou T, Khalili L, Ghavamzadeh S, Shokri A, Payahoo L, Bishak YK. Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Autoimmun Highlights. 2018;9:1.10.1007/s13317-017-0101-xSuche in Google Scholar

[23] Marwaha RK, Yenamandra VK, Sreenivas V, Sahay R, Baruah MP, Desai A, et al. Regional and seasonal variations in ultraviolet B irradiation and vitamin D synthesis in India. Osteoporos Int. 2016;27:1611–7.10.1007/s00198-015-3427-0Suche in Google Scholar PubMed

[24] Doley D, Kakati S, Saikia L, Rajadhyaksha A, Nadkar M, Khadilkar P, et al. A comparative study of anticardiolipin antibodies among systemic lupus erythematosus patients from Western and Eastern India. J Assoc Physicians India. 2017;65:14–9.Suche in Google Scholar PubMed

[25] Kotokey RK, Rajkhowa K, Chaliha MS, Pegu UR. A study of cardiovascular manifestations in systemic lupus erythematosus in upper Assam. J Indian Coll Cardiol. 2012;2:29–32.10.1016/S1561-8811(12)80006-XSuche in Google Scholar

[26] Raphael V, Gogoi P, Khonglah Y, Lynrah KG, Dass R. Spectrum of renal lesions in systemic lupus erythematosus: six years’ experience at a tertiary healthcare centre in northeast India. Indian J Nephrol. 2012;22:399–400.10.4103/0971-4065.103916Suche in Google Scholar PubMed PubMed Central

[27] Kakati S, Barman B, Ahmed SU, Hussain M. Neurological manifestations in systemic lupus erythematosus: a single centre study from northeast India. J Clin Diagn Res. 2017;11:OC05–09.10.7860/JCDR/2017/23773.9280Suche in Google Scholar PubMed PubMed Central

[28] Ritu G, Gupta A. Vitamin D deficiency in India: prevalence, causalities and interventions. Nutrients. 2014;6:729–75.10.3390/nu6020729Suche in Google Scholar PubMed PubMed Central

[29] Hochberg MC. Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum. 1997;40:1725.10.1002/art.1780400928Suche in Google Scholar PubMed

[30] Bombardier C, Gladmsn FF, Urowit MB, Caron D, Chang CH. Derivation of SLEDAI: a disease activity index for lupus patients. The committee on prognosis studies in SLE. Arch Rheum. 1995;35:630–40.10.1002/art.1780350606Suche in Google Scholar PubMed

[31] Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al., Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2011;96:1911–30.10.1210/jc.2011-0385Suche in Google Scholar PubMed

[32] van Schoor N, Lips P. Global overview of vitamin D status. Endocrinol Metab Clin North Am. 2017;46:845–70.10.1016/j.ecl.2017.07.002Suche in Google Scholar PubMed

[33] Ali AN, Das I. Tribal situation in northeast India. Stud Tribes Tribals. 2003;1:141–8.10.1080/0972639X.2003.11886492Suche in Google Scholar

[34] Damanhouri LH. Vitamin D deficiency in Saudi patients with systemic lupus erythematosus. Saudi Med J. 2009;30:1291–5.Suche in Google Scholar PubMed

[35] Iruretagoyena M, Hirigoyen D, Naves R, Burgos PI. Immune response modulation by vitamin D: role in systemic lupus erythematosus. Front Immunol. 2015;6:513.10.3389/fimmu.2015.00513Suche in Google Scholar PubMed PubMed Central

[36] AlSaleem A, AlE’ed A, AlSaghier A, Al-Mayouf SM. Vitamin D status in children with systemic lupus erythematosus and its association with clinical and laboratory parameters. Clin Rheumatol. 2015;34:81–4.10.1007/s10067-014-2811-zSuche in Google Scholar PubMed

[37] Sousa JR, Rosa EP, de Oliveira Costa Nunes IF, de Carvalho CM. Effect of vitamin D supplementation on patients with systemic lupus erythematosus: a systematic review. Rev Bras Reumatol. 2017;57:466–71.10.1016/j.rbre.2017.08.001Suche in Google Scholar PubMed

[38] Hiraki LT, Munger KL, Costenbader KH, Karlson EW. Dietary intake of vitamin D during adolescence and risk of adult-onset systemic lupus erythematosus and rheumatoid arthritis. Arthritis Care Res. 2012;64:1829–36.10.1002/acr.21776Suche in Google Scholar PubMed PubMed Central

[39] Attar SM, Siddiqui AM. Vitamin D deficiency in patients with systemic lupus erythematosus. Oman Med J. 2013;28:42–7.10.5001/omj.2013.10Suche in Google Scholar PubMed PubMed Central

[40] Pakpoor J, Pakpoor J. Vitamin D deficiency and systemic lupus erythematosus: cause or consequence? Oman Med J. 2013;28:295.10.5001/omj.2013.83Suche in Google Scholar PubMed PubMed Central

[41] Mahto H, Tripathy R, Das BK, Panda AK. Association between vitamin D receptor polymorphisms and systemic lupus erythematosus in an Indian cohort. Int J Rheum Dis. 2018;21:468–76.10.1111/1756-185X.13245Suche in Google Scholar PubMed

[42] Zhao M, Duan XH, Wu ZZ, Gao CC, Wang N, Zheng ZH. Severe vitamin D deficiency affects the expression of autophagy related genes in PBMCs and T-cell subsets in active systemic lupus erythematosus. Am J Clin Exp Immunol. 2017;6:43–51.Suche in Google Scholar PubMed

[43] Terrier B, Derian N, Schoindre Y, Chaara W, Geri G, Zahr N, et al. Restoration of regulatory and effector T cell balance and B cell homeostasis in systemic lupus erythematosus patients through vitamin D supplementation. Arthritis Res Ther. 2012;14:R221.10.1186/ar4060Suche in Google Scholar PubMed PubMed Central

[44] Marinho A, Carvalho C, Boleixa D, Bettencourt A, Leal B, Guimaraes J, et al. Vitamin D supplementation effects FoxP3 expression in T cells and FoxP3+/IL-17A ratio and clinical course in systemic lupus erythematosus patients: a study in a Portuguese cohort. Immunol Res. 2017;65:197–206.10.1007/s12026-016-8829-3Suche in Google Scholar PubMed

Supplementary Material

The online version of this article offers supplementary material (DOI: https://doi.org/10.1515/hmbci-2018-0064).

Received: 2018-08-25
Accepted: 2019-02-10
Published Online: 2019-04-03

©2019 Walter de Gruyter GmbH, Berlin/Boston

Artikel in diesem Heft

  1. Original Articles
  2. Vitamin D status and its relationship with systemic lupus erythematosus as a determinant and outcome of disease activity
  3. The physical activity level and aerobic capacity estimation (VO2max) among the administrative staff of the Pars Special Economic Energy Zone (Assaluyeh, Iran) with different BMIs
  4. Review Article
  5. Novel strategies for clinical investigation and biomarker discovery: a guide to applied metabolomics
  6. Case Report
  7. A “miracle” pregnancy outcome of severe placental abruption
https://doi.org/10.1515/hmbci-2018-0064
Schlagwörter für diesen Artikel
25-hydroxyvitamin D; disease activity; risk factor; systemic lupus erythematosus; vitamin D deficiency

Artikel in diesem Heft

  1. Original Articles
  2. Vitamin D status and its relationship with systemic lupus erythematosus as a determinant and outcome of disease activity
  3. The physical activity level and aerobic capacity estimation (VO2max) among the administrative staff of the Pars Special Economic Energy Zone (Assaluyeh, Iran) with different BMIs
  4. Review Article
  5. Novel strategies for clinical investigation and biomarker discovery: a guide to applied metabolomics
  6. Case Report
  7. A “miracle” pregnancy outcome of severe placental abruption
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