AB0582 Effect of Vitamin D Deficiency and Replacement on Endothelial Functions in Familial Mediterrenean Fever

Abstract

Background Although patients with familial Mediterranean fever (FMF) are symptom-free between the attacks, subclinical inflammation may continue. Vitamin D (vit D) plays an important role in the modulation of immune system and might also influence the course of FMF. Endothelial dysfunction is previously demonstrated in Behcet's disease (BD) and vit D is implicated to modulate endothelial functions. Objectives We aimed to evaluate the status of serum 25(OH)Vit D3 levels and its association with disease activity, endothelial function and carotis intima media thickness (CIMT) in patients with FMF. Methods Sixty-two FMF (F/M: 42/20, mean age: 33.5 years), 43 ankylosing spondylitis (AS) (F/M: 19/24, mean age: 40.9 years) patients and 46 healthy controls (HC) (F/M: 26/20, mean age: 34.7 years) were studied. Serum 25(OH)Vit D3 levels were measured by HPLC method. Endothelial function was evaluated by brachial artery flow mediated dilatation (FMD) and CIMT with B-Mode ultrasound. The vitamin D-deficient BD patients received 1000 IU Vitamin D3 daily for 3 months. At the end of the third month of treatment, the subjects were re-evaluated for the same parameters (CIMT and FMD). Results The mean (SD) disease duration was 8.2 (7.8) vs 8.4 (6.5) years (p>0.05) in FMF and AS patients, respectively. All FMF patients were on attack-free period and all of them were on colchicine treatment. A significant difference was observed between the levels of 25(OH)Vit D3 between the groups [median (range): 11.3 (2.7-48.3), 12.7 (4-37) and 56 (14-125), FMF, AS and HC, respectively), p=0,001]. CIMT and FMD measurements were similar between groups (p>0.05). Serum 25(OH)Vit D3 levels were not observed to correlate with CIMT or FMD measurements. A significant increase of 25(OH)VitD3 levels after replacement therapy [11.3 (2.7-48.3), vs 30 (13-72) p=0.001] was observed after 3 months of therapy. Also, after replacement therapy, CIMT measurements improved (1,04 vs 0.50, p=0.001) and FMD measurements improved (4,9 vs 10,2, p=0.01) Conclusions A high presence of Vitamin D deficiency was observed in FMF patients from Turkey. Although impaired vascular endothelial function did not correlate with vitamin D levels, vitamin D deficiency may influence the course of the attacks and be related to some colchicine-resistant cases. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5994

Subclinical atherosclerosis in Behcet’s disease: A systematic review and meta-analysis

“…1), 24 studies met the criteria for inclusion in the analysis: 9 investigated FMD and/or EMD [18][19][20][21][22][23][24][25][26], 11 IMT [8,[27][28][29][30][31][32][33][34][35][36] and 4 investigated both [37][38][39][40].…”

“…All investigators measured IMT at the common carotid artery but for one study where the authors presented the average IMT taken at the distal common carotids, at the far wall of the carotid bulbs and at the far wall of the internal carotid artery [8]. Indeed studies varied with regards to inclusion criteria: n ¼ 3 compared patients with and without vascular involvement and provided separate measurements [27,37,38], n ¼ 1 provided separate data for patients with and without systemic involvement (mucocutaneous only) [36], n ¼ 3 studies included a mixture of active and inactive disease [32,34,40] of which one provided separate data for active and inactive disease [32], n ¼ 3 studies were carried out on patients with low or inactive disease [31,33,35], n ¼ 2 were carried out on patients without vascular and/or systemic involvement [38,39] and n ¼ 2 were carried out in patients without cardiovascular risk factors [28,30].…”

“…BD patients were then split according to active and inactive disease where possible: we arbitrarily considered patients with vascular involvement [20,37,38] as having active disease and pooled them with active disease patients proper [20,22,23,25,26,40]: FMD was significantly lower with moderate heterogeneity (SMD ¼ À1.17, 95% CI: À 1.45 to À 0.89, p ¼ 0.0001, I 2 ¼ 37.5%) (Fig. 2B).…”

“…We therefore extracted data of patients without vascular involvement from the three studies where these data were provided separately [27,37,38], we extracted the data of the patients without systemic involvement [36], we maintained the data of the patients with inactive disease [32] and we excluded the only study where inactive and active disease patients could not To reduce heterogeneity in an opposite fashion, we arbitrarily pooled patients according to (1) active disease, (2) vascular involvement and (3) systemic involvement. We extracted data from patients with systemic involvement [36] and with vascular disease [27,37,38] on the assumption they implied active disease, we removed two studies with a mixture of active and inactive patients [34,40] and repeated the random effect analysis that yielded again wide heterogeneity (I 2 ¼ 86.8%).…”

Etiology, Immunopathogenesis and Biomarkers in Behçet’s disease

“…Moreover, hypovitaminosis D had been implicated in various inflammatory disorders including BD [250][251][252][253][254][255]. Further investigations from different ethnic populations may provide further insights to this potentially clinically relevant knowledge of vitamin D as a potential suppressor of inflammatory response in BD.…”