Vitamin D Levels and Steroid Usage are not Associated with Disease Activity in Systemic Lupus Erythematosus Patients
Main Article Content
Abstract
Introduction: Suboptimal vitamin D levels are commonly presented by systemic lupus erythemathosus (SLE) patients. This is likely due to protection measures from sunshine exposure adopted by SLE patients to reduce the likelihood of SLE flares onset. In this study, we investigated the vitamin D level among SLE patients and its association with SLE Disease Activity (SLEDAI) scores and among groups of steroid and non-steroid usage. Methods: We recruited 84 SLE patients who attended the Rheumatology Clinic of Hospital Universiti Sains Malaysia from June 2018 until October 2018. Their clinico-demographic data were retrieved and serum vitamin D immunoassay was conducted to measure the vitamin D levels of each patient Vitamin D levels were categorized as normal (≥75nmol/L), insufficient (50-74 nmol/L) or deficient (<50 nmol/L). Comparison between the clinico-demographic parameters with vitamin D levels were conducted using the Fisher’s exact test (for categorical variables) and unpaired t-test (for continuous variables).
Results: The mean vitamin D level among the subjects was 40.79 ± 20.2 nmol/L. Fifty-eight (69%) patients were vitamin D deficient, while 20 (23.8%) patients were vitamin D insufficient, and only 6 (7.1%) patients had sufficient level of vitamin D. Vitamin D status was not significantly associated with SLEDAI score (p=0.185) as well as between steroids and non-steroids groups (p=0.255). Conclusion: Vitamin D deficiency occurred in majority of our SLE patients. SLE disease activities were not associated with the status of vitamin D or steroid usage.
Downloads
Article Details
References
Sherer Y, Gorstein A, Fritzler MJ, Shoenfeld Y. Autoantibody explosion in systemic lupus erythematosus: more than 100 different antibodies found in SLE patients. Semin Arthritis Rheum. 2004; 34: 501-37.
Syahidatulamali CS, Wan Syamimee WG, Azwany YN, Wong KK, Che Maraina CH. Association of anti-CLIC2 and anti-HMGB1 autoantibodies with higher disease activity in systemic lupus erythematosus patients. J Postgrad Med. 2017; 63: 257-261.
Muhammad Yusoff F, Wong KK, Mohd Redzwan N. Th1, Th2, and Th17 cytokines in systemic lupus erythematosus. Autoimmunity. 2020; 53: 8-20.
Pan Q, Xiao H, Shi L, et al. IgG4 Autoantibodies Attenuate Systemic Lupus Erythematosus Progression by Suppressing Complement Consumption and Inflammatory Cytokine Production. Front Immunol. 2020; 11: 1047.
Mohd Shukri ND, Farah Izati A, Wan Ghazali WS, Che Hussin CM, Wong KK. CD3(+)CD4(+)gp130(+) T Cells Are Associated With Worse Disease Activity in Systemic Lupus Erythematosus Patients. Front Immunol. 2021; 12: 675250.
Harden OC, Hammad SM. Sphingolipids and Diagnosis, Prognosis, and Organ Damage in Systemic Lupus Erythematosus. Front Immunol. 2020; 11: 586737.
Hong S, Healy H, Kassianos AJ. The Emerging Role of Renal Tubular Epithelial Cells in the Immunological Pathophysiology of Lupus Nephritis. Front Immunol. 2020; 11: 578952.
Ghazali WSW, Daud SMM, Mohammad N, Wong KK. Slicc damage index score in systemic lupus erythematosus patients and its associated factors. Medicine (Baltimore). 2018; 97: e12787.
Salman-Monte TC, Torrente-Segarra V, Vega-Vidal AL, et al. Bone mineral density and vitamin D status in systemic lupus erythematosus (SLE): A systematic review. Autoimmun Rev. 2017; 16: 1155-1159.
Ruaro B, Casabella A, Paolino S, et al. Trabecular Bone Score and Bone Quality in Systemic Lupus Erythematosus Patients. Front Med (Lausanne). 2020; 7: 574842.
Deluca HF, Cantorna MT. Vitamin D: its role and uses in immunology. FASEB J. 2001; 15: 2579-85.
Yamamoto E, Jorgensen TN. Immunological effects of vitamin D and their relations to autoimmunity. J Autoimmun. 2019; 100: 7-16.
Mok C, Birmingham D, Ho L, Hebert L, Song H, Rovin B (2012) Vitamin D defciency as marker for disease activity and damage in systemic lupus erythematosus: a comparison with anti-dsDNA and anti-C1q. Lupus 21:36–42
Tohid H,Leila K. Role of vitamin D defciency in systemic lupus erythematosus incidence and aggravation. Autoimmunity Highlights (2018) 9:1
Attar SM, Siddiqui AM. Vitamin d deficiency in patients with systemic lupus erythematosus. Oman Med J. 2013; 28: 42-7.
Nguyen MH, Bryant K, O’Neill SG. Vitamin D in SLE: a role in pathogenesis and fatigue? A review of the literature. Lupus. 2018; 27: 2003-2011.
Kim HA, Sung JM, Jeon JY, Yoon JM, Suh CH. Vitamin D may not be a good marker of disease activity in Korean patients with systemic lupus erythematosus. Rheumatol Int. 2011; 31: 1189-94.
Eloi M, Horvath DV, Ortega JC, et al. 25-Hydroxivitamin D Serum Concentration, Not Free and Bioavailable Vitamin D, Is Associated with Disease Activity in Systemic Lupus Erythematosus Patients. PLoS One. 2017; 12: e0170323.
Petri M, Orbai AM, Alarcon GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum. 2012; 64: 2677-86.
Bombardier C, Gladman DD, Urowitz MB, Caron D, Chang CH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum. 1992;
: 630-40.
Zahr N, Arnaud L, Marquet P, et al. Mycophenolic acid area under the curve correlates with disease activity in lupus patients treated with mycophenolate mofetil. Arthritis Rheum. 2010; 62: 2047-54.
Talaat RM, Mohamed SF, Bassyouni IH, Raouf AA. Th1/Th2/Th17/Treg cytokine imbalance in systemic lupus erythematosus (SLE) patients: Correlation with disease activity. Cytokine. 2015; 72: 146-53.
Yeap SS, Othman AZ, Zain AA, Chan SP. Vitamin D levels: its relationship to bone mineral density response and disease activity in premenopausal Malaysian systemic lupus erythematosus patients on corticosteroids. Int J Rheum Dis. 2012; 15: 17-24.
Ong SG, Ding HJ. Vitamin D status in a monocentric cohort of systemic lupus erythematosus (SLE) patients and correlations with clinical and immunological profile. The Medical Journal of Malaysia. 2019; 74: 492-498.
Shiao We, Hazreen AM,et al.Risk factors of vitamin D deficiency among 15-year-old adolescents participating in the Malaysian Health and Adolescents Longitudinal Research Team Study (MyHeARTs). PLoS ONE 2019; 13(7)
Lertratanakul A, Wu P, Dyer A, et al. 25-hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort. Arthritis Care Res (Hoboken). 2014; 66: 1167-76.
Souto M, Coelho A, Guo C, et al. Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity. Lupus. 2011; 20: 1019-26.
Yap KS, Northcott M, Hoi AB, 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.
Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C. Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford). 2008; 47: 920-3.
Gao CC, Liu SY, Wu ZZ, et al. Severe vitamin D deficiency increases the risk for moderate to severe disease activity in Chinese patients with SLE. Lupus. 2016; 25: 1224-9.
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: 36-42.
Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Altern Med Rev. 2008; 13: 6-20.
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.
Garcia-Carrasco M, Mendoza-Pinto C, Etchegaray-Morales I, et al. Vitamin D insufficiency and deficiency in mexican patients with systemic lupus erythematosus: Prevalence and relationship with disease activity. Reumatol Clin. 2017; 13: 97-101.
Skversky AL, Kumar J, Abramowitz MK, Kaskel FJ, Melamed ML. Association of glucocorticoid use and low 25-hydroxyvitamin D levels: results from the National Health and Nutrition Examination Survey (NHANES): 2001-2006. J Clin Endocrinol Metab. 2011; 96: 3838-45.
Carvalho JF, Blank M, Kiss E, Tarr T, Amital H, Shoenfeld Y. Anti-vitamin D, vitamin D in SLE: preliminary results. Ann N Y Acad Sci. 2007; 1109: 550-7.
Schoindre Y, Jallouli M, Tanguy ML, et al. 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.
Borba VZ, Vieira JG, Kasamatsu T, Radominski SC, Sato EI, Lazaretti-Castro M. Vitamin D deficiency in patients with active systemic lupus erythematosus. Osteoporos Int. 2009; 20: 427-33.
Amital H, Szekanecz Z, Szucs G, et al. 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. 2010; 69: 1155-7.