Lower Levels of Vitamin D Associated with Disease Activity in Colombian Patients with Systemic Lupus Erythematosus

Author(s): Ana Isabel Ospina-Caicedo, Alex Darío Cardona-Rincón, Juan Manuel Bello-Gualtero, Rafael Valle-Oñate, Consuelo Romero-Sánchez*, Philippe Chalem-Choueka, Gloria Vásquez Duque

Journal Name: Current Rheumatology Reviews

Volume 15 , Issue 2 , 2019


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Graphical Abstract:


Abstract:

Background: Systemic Lupus Erythematosus (SLE) involves genetic, environmental, and hormonal alterations, including Vitamin D deficiency.

Objective: To evaluate the association between vitamin D levels with anti-dsDNA, complement proteins, immunoglobulins levels and disease activity scores.

Methods: A cross-sectional study was performed. The levels of 25-OH vitamin D were measured in patients older than 18 years with SLE according to ACR/97 [American College of Rheumatology 1997] from 2013 to 2015. The association was assessed by Mann-Whitney U and Kruskal Wallis tests for continuous variables, and by the Chi or Fisher exact test for the nominal variables.

Results: Sixty-nine patients were included; 82% were women; the mean age was 38.5 years; 36.2% had low levels of vitamin D with higher consumption [p=0.006] of C4 and C3 complement proteins, plus higher levels of anti-dsDNA. Lower values of vitamin D were observed in patients with moderate to severe activity [p=0.0001] by SLEDAI [Systemic Lupus Erythematosus Activity Index] and general domain [p=0.039] and renal domain [p=0.009] by BILAG [British Isles Lupus Assessment Group] 2004. The mean vitamin D levels were higher in the group not receiving steroids when compared to those groups with dosages of 0.5-1mg/kg/d [p=0.048].

Conclusion: Lower levels of vitamin D are associated with greater complement protein consumption and higher disease activity rates. Therefore, it is important to evaluate vitamin D supplementation in patients with SLE as part of the treatment, especially when it includes the use of steroids.

Keywords: Vitamin D, SLE, outcomes assessment, C3 complement, lupus nephritis, colombian patients.

[1]
Hahn BH. The pathogenesis of SLEDubois’ lupus erythematosus and related syndromes 8th Ed. 2013. [pp. 25-34]
[2]
Kamen DL. Environmental influences on systemic lupus erythematosus expression. Rheum Dis Clin North Am 2014; 40(3): 401-12. [vii.].
[3]
Wu Z, Li X, Qin H, Zhu X, Xu J, Shi W. Ultraviolet B enhances DNA hypomethylation of CD4+ T cells in systemic lupus erythematosus via inhibiting DNMT1 catalytic activity. J Dermatol Sci 2013; 71(3): 167-73.
[4]
Elliott JR, Manzi S. Cardiovascular risk assessment and treatment in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2009; 23(4): 481-94.
[5]
Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: Comparison with the framingham study. Am J Epidemiol 1997; 145(5): 408-15.
[6]
Danza A, Ruiz-Irastorza G. Infection risk in systemic lupus erythematosus patients: susceptibility factors and preventive strategies. Lupus 2013; 22(12): 1286-94.
[7]
Bernatsky S, Boivin JF, Joseph L, et al. Race/ethnicity and cancer occurrence in systemic lupus erythematosus. Arthritis Rheum 2005; 53(5): 781-4.
[8]
Cutolo M, Otsa K. Review: Vitamin D, immunity and lupus. Lupus 2008; 17(1): 6-10.
[9]
Cutolo M, Otsa K, Paolino S, Yprus M, Veldi T, Seriolo B. Vitamin D involvement in rheumatoid arthritis and systemic lupus erythaematosus. Ann Rheum Dis 2009; 68(3): 446-7.
[10]
Cutolo M, Pizzorni C, Sulli A. Vitamin D endocrine system involvement in autoimmune rheumatic diseases. Autoimmun Rev 2011; 11(2): 84-7.
[11]
Fernandez KA. Vitamin D y factores de riesgo cardiovascular en LES 2013. Tesis doctoral
[12]
Ritterhouse LL, Crowe SR, Niewold TB, et al. Vitamin D deficiency is associated with an increased autoimmune response in healthy individuals and in patients with systemic lupus erythematosus. Ann Rheum Dis 2011; 70(9): 1569-74.
[13]
Kamen DL. Vitamin D in lupus - new kid on the block? Bull NYU Hosp Jt Dis 2010; 68(3): 218-22.
[14]
Singh A, Kamen DL. Potential benefits of vitamin D for patients with systemic lupus erythematosus. Dermatoendocrinol 2012; 4(2): 146-51.
[15]
Adorini L, Penna G. Control of autoimmune diseases by the vitamin D endocrine system. Nat Clin Pract Rheumatol 2008; 4(8): 404-12.
[16]
Grant WB. Epidemiology of disease risks in relation to vitamin D insufficiency. Prog Biophys Mol Biol 2006; 92(1): 65-79.
[17]
Sahebari M, Nabavi N, Salehi M. Correlation between serum 25(OH)D values and lupus disease activity: An original article and a systematic review with meta-analysis focusing on serum VitD confounders. Lupus 2014; 23(11): 1164-77.
[18]
Stagi S, Cavalli L, Bertini F, et al. Vitamin D levels in children, adolescents, and young adults with juvenile-onset systemic lupus erythematosus: A cross-sectional study. Lupus 2014; 23(10): 1059-65.
[19]
Kalim H, Wahono S, Puspitasari L, et al. Association between serum level of Vitamin D with autoantibodies expression, disease activity [SLEDAI] and Bone Mineral Density [BMD] in patients with Systemic Lupus Erythematosus. Arth Res Ther 2012; 14(1): 1. [SLE].
[20]
Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31(3): 315-24.
[21]
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. Arthritis Rheum 1992; 35(6): 630-40.
[22]
Isenberg DA, Rahman A, Allen E, et al. BILAG 2004. Development and initial validation of an updated version of the British Isles Lupus Assessment Group’s disease activity index for patients with systemic lupus erythematosus. Rheumatology (Oxford) 2005; 44(7): 902-6.
[23]
LeFevre MLUS. Preventive Services Task Force. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015; 162(2): 133-40.
[24]
Zuluaga-Espinosa NA, Alfaro-Velázquez JM. González VB y col.Vitamin D: Nuevos paradigmas.Med Lab (Ed Ital) . 2011; 17: pp. 211-46.
[25]
Azrielant S, Shoenfeld Y. Eppur Si Muove: Vitamin D is essential in preventing and modulating SLE. Lupus 2016; 25(6): 563-72.
[26]
U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Ed. [Inter-net]. 2015. [Revisado 20 deoctubre de 2016] Disponible. http://health.gov/dietaryguidelines/2015/guidelines/
[27]
Léger-Guist’hau J, Domingues-Faria C, Miolanne M, et al. Low socio-economic status is a newly identified independent risk factor for poor vitamin D status in severely obese adults. J Hum Nutr Diet 2017; 30(2): 203-15.
[28]
Davis SV. The Relationship Between Socioeconomic Status and Body Mass Index on Vitamin D Levels in African American Women with and without Diabetes Living in Areas with Abundant Sunshine [Internet].. 2013. [Revisado 5 de septiembre de 2016]. 2013.
[29]
Mansuri ZH, Kaji BC, Dumra S, Buch HN. Hypervitaminosis-D, an uncommon reality! J Assoc Physicians India 2014; 62(10): 58-60.
[30]
Marins TA, Galvão Tde F, Korkes F, et al. Vitamin D intoxication: case report. Einstein (Sao Paulo) 2014; 12(2): 242-4.
[31]
Ketha H, Wadams H, Lteif A, Singh RJ. Iatrogenic vitamin D toxicity in an infant--a case report and review of literature. J Steroid Biochem Mol Biol 2015; 148: 14-8.
[32]
Khan AH, Majid H, Iqbal R. Shifting of vitamin D deficiency to hypervitaminosis and toxicity. J Coll Physicians Surg Pak 2014; 24(7): 536.
[33]
Gouni-Berthold I, Krone W, Berthold HK. Vitamin D and cardiovascular disease. Curr Vasc Pharmacol 2009; 7(3): 414-22.
[34]
Haidari F, Zakerkish M, Karandish M, Saki A, Pooraziz S. Association between Serum Vitamin D Level and Glycemic and Inflammatory Markers in Non-obese Patients with Type 2 Diabetes. Iran J Med Sci 2016; 41(5): 367-73.
[35]
Agarwal S, Kovilam O, Agrawal DK. Vitamin D and its impact on maternal-fetal outcomes in pregnancy: A critical review. Crit Rev Food Sci Nut 2016; pp. 1-15.
[36]
Hiremath GS, Cettomai D, Baynes M, et al. Vitamin D status and effect of low-dose cholecalciferol and high-dose ergocalciferol supplementation in multiple sclerosis. Mult Scler 2009; 15(6): 735-40.
[37]
Sampaio-Barros MM, Takayama L, Sampaio-Barros PD, Bonfá E, Pereira RM. Low vitamin D serum levels in diffuse systemic sclerosis: a correlation with worst quality of life and severe capillaroscopic findings. Rev Bras Reumatol Engl Ed 2016; 56(4): 337-44.
[38]
Liu C, Lu M, Xia X, et al. Correlation of serum vitamin D level with type 1 diabetes mellitus in children: A meta-analysis. Nutr Hosp 2015; 32(4): 1591-4.
[39]
Frigstad SO, Høivik M, Jahnsen J, et al. Vitamin D deficiency in inflammatory bowel disease: Prevalence and predictors in a Norwegian outpatient population. Scand J Gastroenterol 2017; 52(1): 100-6.
[40]
Raczkiewicz A, Kisiel B, Kulig M, Tłustochowicz W. Vitamin D status and its association with quality of life, physical activity, and disease activity in rheumatoid arthritis patients. J Clin Rheumatol 2015; 21(3): 126-30.
[41]
García-Carrasco M, Mendoza-Pinto C, Ayón-Aguilar J, et al. [Serum levels of vitamin D in systemic lupus erythematosus patients (SLE) and their relationship with disease activity: longitudinal study]. Gac Med Mex 2016; 152(Suppl. 2): 32-7.
[42]
Attar SM, Siddiqui AM. Vitamin d deficiency in patients with systemic lupus erythematosus. Oman Med J 2013; 28(1): 42-7.
[43]
Szodoray P, Tarr T, Bazso A, Poor G, Szegedi G, Kiss E. The immunopathological role of vitamin D in patients with SLE: data from a single centre registry in Hungary. Scand J Rheumatol 2011; 40(2): 122-6.
[44]
Petri MA, Bello KJ, Fang H, et al. Vitamin D Levels Are Positively Associated with Complement among Patients with SLE. Arthritis Rheum 2010; 62(Suppl. 10): 1180.
[45]
Tesar V, Hruskova Z. Lupus Nephritis: A Different Disease in European Patients? Kidney Dis (Basel) 2015; 1(2): 110-8.
[46]
Pons-Estel BA, Catoggio LJ, Cardiel MH, et al. The GLADEL multinational Latin American prospective inception cohort of 1,214 patients with systemic lupus erythematosus: Ethnic and disease heterogeneity among “Hispanics”. Medicine (Baltimore) 2004; 83(1): 1-17.
[47]
Turchetti G, Yazdany J, Palla I, et al. Systemic lupus erythematosus and the economic perspective: A systematic literature review and points to consider. Clin Exp Rheumatol 2012; 30: S116.
[48]
Quintana G, Coral A, Díaz J. Direct costs of health care of lupus nephritis in Colombia. Ann Rheum Dis 2011; 70(Suppl. 13): 694.
[49]
Mok CC, Birmingham DJ, Ho LY, Hebert LA, Song H, Rovin BH. Vitamin D deficiency as marker for disease activity and damage in systemic lupus erythematosus: A comparison with anti-dsDNA and anti-C1q. Lupus 2012; 21(1): 36-42.
[50]
Chen S, Sims GP, Chen XX, Gu YY, Chen S, Lipsky PE. Modulatory effects of 1,25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol 2007; 179(3): 1634-47.
[51]
Geldmeyer-Hilt K, Heine G, Hartmann B, Baumgrass R, Radbruch A, Worm M. 1,25-dihydroxyvitamin D3 impairs NF-κB activation in human naïve B cells. Biochem Biophys Res Commun 2011; 407(4): 699-702.
[52]
He XJ, Ding Y, Xiang W, Dang XQ. Roles of 1,25(OH)2D3 and Vitamin D Receptor in the Pathogenesis of Rheumatoid Arthritis and Systemic Lupus Erythematosus by Regulating the Activation of CD4+ T Cells and the PKCδ/ERK Signaling Pathway. Cell Physiol Biochem 2016; 40(3-4): 743-56.
[53]
Blaese RM, Grayson J, Steinberg AD. Increased immunoglobulin-secreting cells in the blood of patients with active systemic lupus erythematosus. Am J Med 1980; 69(3): 345-50.
[54]
Gripenberg M, Helve T. Anti-DNA antibodies of IgA class in patients with systemic lupus erythematosus. Rheumatol Int 1986; 6(2): 53-5.
[55]
Mantovani APF, Monclaro MP, Skare TL. Prevalence of IgA deficiency in adult systemic lupus erythematosus and the study of the association with its clinical and autoantibody profiles. Rev Bras Reumatol 2010; 50(3): 273-82.
[56]
Yap DYH, Yung S, Ma MKM, et al. Serum immunoglobulin G level in patients with lupus nephritis and the effect of treatment with corticosteroids and mycophenolate mofetil. Lupus 2014; 23(7): 678-83.


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Article Details

VOLUME: 15
ISSUE: 2
Year: 2019
Published on: 04 April, 2019
Page: [146 - 153]
Pages: 8
DOI: 10.2174/1573397114666181015161547
Price: $65

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