The role of vitamin D3 deficiency correction in optimizing the treatment of anemia in women with autoimmune diseases

The aim is to analyze the effectiveness of correction vitamin D deficiency in the treatment of anemia in women with systemic lupus erythematosus (SLE). Materials and methods. Concomitant documented levels of 25-hydroxyvitamin D, hemoglobin, ferritin, and serum iron in a group of women with SLE who applied for preconception counseling were analyzed. All women were in remission for SLE activity within 5 to 6 months. A total of 54 women were involved in iron metabolism disorders (decreased ferritin, hemoglobin, serum iron). Vitamin D deficiency was detected at <30 ng/ml, and anemia at hemoglobin <120 g/l. Group 1 consisted of 32 women with vitamin D levels <30 ng/ml who received antianemic therapy with ferrous sulfate with ascorbic acid, correction of vitamin D deficiency with Olidetrim 2000 U (Polpharma), and group 2 — women with vitamin D levels <30 ng/ml (n=22) who received antianemic therapy with ferrous sulfate with ascorbic acid and a vitamin complex containing vitamin D 400 U. The groups were comparable by the main demographic indicators (age, education, socio-economic level). In both groups, iron metabolism and 25-hydroxyvitamin D levels were monitored in 4 weeks after treatment. Results and conclusions. Women with SLE have a high risk of chronic inflammatory anemia development, which can be combined with iron deficiency anemia. To improve the results of treatment, it is proposed to introduce supplementation with a high dose of vitamin D (Olidetrim 2000 U), into complex therapy which contributes to the effectiveness of correction of deficiency of this vitamin, as well as the onset of long-term recovery of iron store, hemoglobin concentration. The study was conducted in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of women was obtained for the research. The authors declare no conflict of interest. Key words: vitamin D deficiency, pregnant women, systemic lupus erythematosus, supplementation.

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The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus

Rheumatology International ◽

10.1007/s00296-012-2537-7 ◽

2012 ◽

Vol 33 (6) ◽

pp. 1461-1467 ◽

Cited By ~ 30

Author(s):

Kittiwan Sumethkul ◽

Smonporn Boonyaratavej ◽

Tasanee Kitumnuaypong ◽

Sungchai Angthararuk ◽

Patcharin Cheewasat ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Predictive Factors ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Low Serum

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To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus

The Open Rheumatology Journal ◽

10.2174/1874312901812010226 ◽

2018 ◽

Vol 12 (1) ◽

pp. 226-247 ◽

Cited By ~ 1

Author(s):

Alessandra Nerviani ◽

Daniele Mauro ◽

Michele Gilio ◽

Rosa Daniela Grembiale ◽

Myles J. Lewis

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Vitamin D Supplementation ◽

Current Evidence ◽

Systemic Lupus ◽

Vitamin D Receptors ◽

Vitamin D Levels

Background: Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations. Objective: Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE. Method: A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here. Conclusion: Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.

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Vitamin D Deficiency in Egyptian Systemic Lupus Erythematosus Patients: How Prevalent and Does it Impact Disease Activity?

Integrative Medicine Insights ◽

10.4137/imi.s40035 ◽

2016 ◽

Vol 11 ◽

pp. IMI.S40035 ◽

Cited By ~ 11

Author(s):

Nouran M. Abaza ◽

Reem M. El-Mallah ◽

Asmaa Shaaban ◽

Sameh A. Mobasher ◽

Khaled F. Al-hassanein ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Activity Index ◽

Damage Index ◽

Systemic Lupus ◽

Vitamin D Levels ◽

Significant Difference

Background The emerging role of vitamin D in immunology and autoimmune disorders has been a worldwide interest in the last decade. Systemic lupus erythematosus (SLE) patients are particularly at a delicate position predisposing them to suffer from vitamin D deficiency due to the multiple risk factors accompanying the disease. Whether vitamin D deficiency is also involved as a risk factor for developing SLE and affecting its course is a considerable concern. Objectives The objective of this study was to estimate the prevalence of vitamin D deficiency in SLE patients and its relation to disease. MATERIALS AND METHODS: In our observational cross-sectional study, serum levels of vitamin D [25(OH)D] in 60 SLE patients and 30 age- and sex-matched healthy controls were assessed and estimated for deficiency and insufficiency at 10 and 30 ng/mL, respectively. Disease activity was evaluated by SLE disease activity index (SLEDAI), irreversible organ damage by Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SLICC/ACR DI), and severity by Severity of Disease Index. Fatigue was measured by visual analog scale. Results Significantly lower levels of 25(OH)D were found in SLE patients (17.6 ± 6.9 ng/mL) in comparison to controls (79.0 ± 28.7 ng/mL), with a statistically high significant difference ( t = -11.2, P < 0.001). High prevalence of vitamin D insufficiency and deficiency was detected as 73.3% and 23.3%, respectively. Vitamin D had a highly significant negative correlation with SLEDAI ( r = -0.495, P < 0.001), SLICC ( r = -0.431, P < 0.05), and fatigue ( r = -0.436, P < 0.05). Conclusion Vitamin D deficiency and insufficiency were found to be prevalent in SLE patients in our study and related to disease activity and fatigue. If needed, routine screening and consequent repletion of vitamin D are recommended in SLE patients. Restoring adequate vitamin D levels in SLE patients should be more explored as a potential yet simple measure to their usual management to improve their condition.

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

Proceedings of The Nutrition Society ◽

10.1017/s0029665111001613 ◽

2011 ◽

Vol 70 (4) ◽

pp. 399-407 ◽

Cited By ~ 10

Author(s):

Leanne C. Breslin ◽

Pamela J. Magee ◽

Julie M. W. Wallace ◽

Emeir M. McSorley

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Disease Activity ◽

Lupus Erythematosus ◽

Additional Stress ◽

Vitamin D Status ◽

Systemic Lupus ◽

Hydroxyvitamin D ◽

Increased Risk ◽

25 Hydroxyvitamin D

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 D3, 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 Levels are Associated with Disease Activity and Damage Accrual in Systemic Lupus Erythematosus Patients

Biological Research For Nursing ◽

10.1177/1099800420983596 ◽

2020 ◽

pp. 109980042098359

Author(s):

María Correa-Rodríguez ◽

Gabriela Pocovi-Gerardino ◽

José-Luis Callejas-Rubio ◽

Raquel Ríos-Fernández ◽

María Martín-Amada ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Disease Activity ◽

Vitamin D Deficiency ◽

Lupus Erythematosus ◽

Clinical Manifestations ◽

Systemic Lupus ◽

Vitamin D Levels ◽

Damage Accrual ◽

The Impact

Vitamin D has immunosuppressive properties and is considered a therapeutic option, although there is controversy about the role of this vitamin in the pathogenesis of systemic lupus erythematosus (SLE). We aimed to determine the prevalence of vitamin D insufficiency and deficiency and their potential association with disease activity, damage accrual, SLE-related clinical manifestations, and cardiovascular risk factors in SLE patients. A cross-sectional study of 264 patients was conducted (89.4% females; mean age 46.7 ± 12.9 years). The SLE Disease Activity Index (SLEDAI-2 K) and the SDI Damage Index were used to assess disease activity and disease-related damage, respectively. The mean 25(OH)D value was 25.1 ± 13.0 ng/ml. Eleven patients (4.2%) had 25(OH)D <10 (deficiency) and 178 patients (70.6%) had 25(OH)D <30 (insufficiency). In the 25(OH)D deficiency group, SLEDAI was significantly higher than the insufficiency ( p = 0.001) and normal groups ( p < 0.001). Also, patients with vitamin D deficiency presented significantly higher SDI scores than patients with 25(OH)D insufficiency ( p = 0.033) and 25(OH)D normal levels ( p = 0.029). There is a high prevalence of both vitamin D deficiency and insufficiency in Caucasian SLE patients and this status was associated with higher SLEDAI and SDI scores, supporting the impact of vitamin D levels on disease activity and damage accrual in SLE patients. Longitudinal studies on the relationship between vitamin D status and disease activity and progression are therefore required.

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Vitamin D levels in male patients with systemic lupus erythematosus

Bone Abstracts ◽

10.1530/boneabs.3.pp250 ◽

2014 ◽

Author(s):

Cristina Vergara ◽

Angels Martinez-Ferrer ◽

Elvira Vicens ◽

Elia Valls ◽

Jose Oller ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Vitamin D ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Vitamin D Levels ◽

Male Patients

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THU0235 VITAMIN D AND INTERFERON SIGNATURE GENE EXPRESSION IN SYSTEMIC LUPUS ERYTHEMATOSUS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.934 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 344.3-345

Author(s):

R. Magro ◽

C. Saliba ◽

L. Camilleri ◽

C. Scerri ◽

A. Borg

Keyword(s):

Gene Expression ◽

Vitamin D ◽

Disease Activity ◽

Lupus Erythematosus ◽

Significant Negative Correlation ◽

Systemic Lupus ◽

Interferon Signature ◽

Hydroxyvitamin D ◽

Signature Genes ◽

25 Hydroxyvitamin D

Background:Vitamin D deficiency is more prevalent in patients with systemic lupus eythematosus (SLE) as a result of sun avoidance.1The potential negative impact of vitamin D deficiency on SLE disease activity has been shown in a number of studies.2The expression of the interferon signature genes in SLE correlates positively with disease activity, and these genes are thought to mediate the clinical manifestations of the disease.3Objectives:The aim of this study was to establish whether a relationship exists between serum 25-hydroxyvitamin D level and the interferon signature gene expression in whole blood of SLE patients.Methods:Informed consent was obtained from 92 SLE patients who were over the age of 18 and who fulfilled the SLICC classification criteria for SLE. The patients were interviewed and blood samples were taken. SLE disease activity was measured by SLE disease activity index-2K (SLEDAI-2K). RNA extraction was performed from whole blood. QuantiGene Plex technology was used to measure the expression of 12 interferon signature genes in the extracted RNA. The study was approved by the University Research Ethics Committee.Results:92.4% of the cohort studied were female. 58.7% were receiving vitamin D3 supplementation at a mean dose of 1031IU daily. 27.2% had vitamin D insufficiency (25-hydroxyvitamin D 21-29ng/ml) and 15.2% were vitamin D deficient (25-hydroxyvitamin D <20ng/ml). Mean serum 25-hydroxyvitamin D was 30.75ng/ml (standard deviation 9.53 ng/ml). Median SLEDAI-2K was 4 (range 0-12). Serum 25-hydroxyvitamin D had a significant negative correlation with body mass index (BMI) (R=-0.258, p=0.006) but there was no significant negative correlation with SLEDAI-2K or with the expression of the interferon signature genes. The expression of most interferon signatures genes measured (IFI35, OAS1, MX1, IFITM1, STAT2, IFIT3, IFIT1, STAT1, SOCS1) had a significant positive correlation with SLEDAI-2K.Conclusion:This study did not show a significant relationship between serum vitamin D level and disease activity. In keeping with this, there was no significant negative correlation between serum 25-hydroxyvitamin D and interferon signature gene expression. Further prospective studies and randomised controlled trials are required to study this relationship in greater depth.References:[1]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.[2]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.Lupus2014; 23: 1164-77.[3]Arasappan D, Tong W, Mummaneni P, Fang H, Amur S. Meta-analysis of microarray data using a pathway-based approach identifies a 37-gene expression signature for systemic lupus erythematosus in human peripheral blood mononuclear cells. BMC Med. 2011; 9: 65.Disclosure of Interests: :None declared

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