Document Type : Original Article

Authors

1 Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran

3 Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran

4 Halal Research Centers of IRI, FDA, Tehran, Iran

Abstract

Abstract
Background and aims: : Systemic lupus erythematosus (SLE) is an autoimmune disease which involves
various organs. Vitamin D is an essential ingredient in regulating the immune system. This study aimed
to investigate the relationship between vitamin D and the severity of lupus activity.
Materials and Methods: This case-control study was carried out on 38 patients with lupus on the basis
of the American College of Rheumatology (ACR) criteria and 44 healthy subjects with no history of
rheumatologic disease. To measure the level of 25-hydroxy vitamin D, venous blood samples (5 cc)
were taken from each participant and the activity of the lupus disease was measured by the Systemic
Lupus Erythematosus Disease Activity Index (SLEDAI) scale. Finally, the chi-square test, independent
sample t test, one-way ANOVA, and multiple linear regression analysis were used to measure
multivariate effects. The level of significance was set to be P < 0.05.
Results: Thirty-five lupus patients and 40 healthy subjects were females (P = 0.847). Vitamin D
deficiency was observed in the case (42.1%) and control (11.4%) groups. The mean value of serum
vitamin D3 level was 35.3 ng/mL in the control group, as well as 24.6 ng/mL and 21.3 ng/mL in
patients with mild and severe SLE, respectively (P = 0.024).
Conclusion: In this study, high levels of 25-hydroxy vitamin D were observed among the healthy
subjects compared to patients with SLE. Eventually, the level of vitamin D significantly decreased by
increasing the severity of SLE activity.

Keywords

1.Tikly M, Navarra SV. Lupus in the developing world--is it any different? Best Pract Res Clin Rheumatol. 2008;22(4):643-55. doi: 10.1016/j.berh.2008.05.003. 
2.Bringhurst FR, Demay MB, Krane SM, Kronenberg HM. Disorders of bone and mineral metabolism. In: Harrison’s Principles of Internal Medicine. New York: McGraw-Hill; 2002. 
3.Toloza SM, Cole DE, Gladman DD, Ibañez D, Urowitz MB. Vitamin D insufficiency in a large female SLE cohort. Lupus. 2010;19(1):13-9. doi: 10.1177/0961203309345775. 
4.Tripkovic L, Lambert H, Hart K, Smith CP, Bucca G, Penson S, et al. Comparison of vitamin D2 and vitamin D3 supplementation in raising serum 25-hydroxyvitamin D status: a systematic review and meta-analysis. Am J Clin Nutr. 2012;95(6):1357- 64. doi: 10.3945/ajcn.111.031070. 
5.Prietl B, Treiber G, Pieber TR, Amrein K. Vitamin D and immune function. Nutrients. 2013;5(7):2502-21. doi: 10.3390/ nu5072502. 
6.Heaney RP. Vitamin D in health and disease. Clin J Am Soc Nephrol. 2008;3(5):1535-41. doi: 10.2215/cjn.01160308. 
7.Basit S. Vitamin D in health and disease: a literature review. Br J Biomed Sci. 2013;70(4):161-72. doi: 10.1080/09674845.2013.11669951. 
8.Richards JB, Valdes AM, Gardner JP, Paximadas D, Kimura M, Nessa A, et al. Higher serum vitamin D concentrations are associated with longer leukocyte telomere length in women. Am J Clin Nutr. 2007;86(5):1420-5. doi: 10.1093/ ajcn/86.5.1420. 
9.Kamen DL, Aranow C. The link between vitamin D deficiency and systemic lupus erythematosus. Curr Rheumatol Rep. 2008;10(4):273-80. doi: 10.1007/s11926-008-0044-3. 
10.Kokic V, Martinovic Kaliterna D, Radic M, Perkovic D, Cvek M, Capkun V. Relationship between vitamin D, IFN-gamma, and E2 levels in systemic lupus erythematosus. Lupus. 2016;25(3):282-8. doi: 10.1177/0961203315605367. 
11.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. doi: 10.1136/ard.2008.093476. 
12.Abou-Raya A, Abou-Raya S, Helmii M. The effect of vitamin D supplementation on inflammatory and hemostatic markers and disease activity in patients with systemic lupus erythematosus: a randomized placebo-controlled trial. J Rheumatol. 2013;40(3):265-72. doi: 10.3899/jrheum.111594. 
13.Amital H, Szekanecz Z, Szücs G, Dankó K, Nagy E, Csépány T, 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(6):1155-7. doi: 10.1136/ard.2009.120329. 
14.Singh A, Kamen DL. Potential benefits of vitamin D for patients with systemic lupus erythematosus. Dermatoendocrinol. 2012;4(2):146-51. doi: 10.4161/derm.20443. 
15.Raiten DJ, Picciano MF. Vitamin D and health in the 21st century: bone and beyond. Executive summary. Am J Clin Nutr. 2004;80(6 Suppl):1673S-7S. doi: 10.1093/ajcn/80.6.1673S. 
16.Manios Y, Moschonis G, Lambrinou CP, Mavrogianni C, Tsirigoti L, Hoeller U, et al. Associations of vitamin D status with dietary intakes and physical activity levels among adults from seven European countries: the Food4Me study. Eur J Nutr. 2018;57(4):1357-68. doi: 10.1007/s00394-017-1415-1. 
17.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. 2008 Jun 1;47(6):920-3. 
18.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. doi: 10.3109/03009742.2010.507220. 
19.Sakthiswary R, Raymond AA. The clinical significance of vitamin D in systemic lupus erythematosus: a systematic review. PLoS One. 2013;8(1):e55275. doi: 10.1371/journal. pone.0055275. 
20.Sassi F, Tamone C, D’Amelio P. Vitamin D: nutrient, hormone, and immunomodulator. Nutrients. 2018;10(11). doi: 10.3390/ nu10111656. 
21.Bonakdar ZS, Jahanshahifar L, Jahanshahifar F, Gholamrezaei A. Vitamin D deficiency and its association with disease activity in new cases of systemic lupus erythematosus. Lupus. 2011;20(11):1155-60. doi: 10.1177/0961203311405703. 
22.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(9):1189-94. doi: 10.1007/s00296-010-1442-1. 
23.Mok C, Singh R, Jannetto P. 450 Serum 25-hydroxyvitamin D3 levels and flares of systemic lupus erythematosus: a longitudinal cohort analysis. Lupus Sci Med. 2017;4(Suppl 1):A216. doi: 10.1136/lupus-2017-000215.450.