Effects of Vitamin D on Systemic Lupus Erythematosus Disease Activity and Autoimmunity: A Systematic Review and Meta-Analysis

Abstract

This study aims to assess the role of vitamin D on systemic lupus erythematosus (SLE) patients and its effects on systemic lupus erythematosus disease activity index (SLEDAI), anti-double-stranded DNA (anti-dsDNA), C3, C4, and fatigue in patients with SLE. A systemic search was conducted using three electronic databases, i.e., PubMed/Medline, Cochrane Library, and Google Scholar. Review Manager 5.4.1 (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was employed for statistical analysis. All studies meeting the inclusion criteria were selected. A random-effect model was used to pool the studies, and the result was reported in the standard mean difference (SMD) with its corresponding 95% confidence interval. Six randomized controlled trials were selected. Five outcomes were assessed (SLEDAI, anti-dsDNA, C3, C4, and fatigue) to evaluate the role of vitamin D in SLE patients. A significant decrease in SLEDAI (SMD = -0.85 (-1.12, -0.58); p < 0.00001; I 2 = 42%) and a non-significant decrease in anti-dsDNA (SMD = -0.09 (-0.03, 0.12); p = 0.42; I 2 = 0%) was noted. A significant increase in levels of C3 (SMD = 0.30 (0.09, 0.51); p = 0.006; I 2 = 0%) and fatigue (SMD = -1.27 (-2.38, -0.16); p = 0.02; I 2 = 56%) was noted when vitamin D was used. Insignificant difference was observed in C4 (SMD = 0.20 (-0.02, 0.41); p = 0.07; I 2 = 0%). Vitamin D in SLE patients showed a significant decrease in SLEDAI scores and a significant increase in C3 levels. The effect of vitamin D on fatigue was inconclusive. No significant difference in anti-dsDNA and C4 levels was noted.

Differential impact of environmental factors on systemic and localized autoimmunity

“…In lupus, cross-sectional studies exploring the impact of supplementation on fatigue and clinical disease activity measures have failed to show a benefit of supplementation, while prospective studies and RCTs have shown a benefit, possibly through a suppression of interferon signature gene expression which is elevated in SLE patients and correlated to disease activity (353)(354)(355)(356)(357)(358). A meta-analysis of available RCTs showed a significant improvement in SLEDAI scores, fatigue (when assessed in two studies), and serum C3; in contrast, serum C4 and anti-dsDNA changes were insignificant (359). In AA, application of topical calcipotriol, a vitamin D analogue, has been shown to be an effective treatment in most mild-to-moderate patients (298,360,361), particularly those with deficiencies (362).…”

The role of vitamin D in pediatric systemic lupus erythematosus - a double pawn in the immune and microbial balance

“…In the same direction, Irfan SA. et col. attests, with the help of a meta-analysis that included studies focused on adult populations, the positive effect of vitamin D3 supplementation on the disease activity score and the serum level of the C3 fraction of the complement, but not on the C4 fraction and anti-dsDNA antibodies ( 112 ). Also, the low level of 25(OH)D correlates with osteoporosis, fatigue and potentiation of cardiovascular risk factors (decrease in renin activity, increase in peripheral resistance to insulin, reduced immunomodulatory effects, alteration endothelial function and increased coronary artery calcification).…”

Deficiência e insuficiência da vitamina D em uma coorte da população de Pernambuco, Brasil

“…Alguns estudos destacam o papel da vitamina D na modulação do sistema imunológico inato e adaptativo, onde essa substância pode ser utilizada para o tratamento adjuvante de muitas doenças imunomediadas. Um baixo nível de 25(OH)D está associado à presença e gravidade da maioria, se não de todas as doenças imunológicas como Artrite Reumatóide (AR), Lúpus Eritematoso Sistêmico (LES) e Síndrome de Sjogren primária (SSp) (Garcia-Carrasco et al, 2017;Croia et al, 2019;Irfan et al, 2022).…”