Low vitamin D status in systemic sclerosis and the impact on disease phenotype

Groşeanu, L.; Bojincă, V.; Gudu, T.; Saulescu, I.; Predeţeanu, Denisa; Bălănescu, Andra; Berghea, F.; Opriş, D.; Borangiu, A.; Constantinescu, C; Negru, M. M.; Ionescu, Ruxandra

doi:10.5152/eurjrheum.2015.0065

Cited by 38 publications

(61 citation statements)

References 36 publications

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“…A severe lung involvement was already described in SSc patients with low 25(OH)D serum concentrations [21]. In the present study however, we do not observe a linear correlation between 25(OH)D concentration and DLCO values, but only a more severe 25(OH)D deficiency was observed in patients with bilateral pulmonary fibrosis on lung CT scan compared to those with milder/no lung involvement.…”

Section: Discussioncontrasting

confidence: 74%

Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments

Trombetta¹,

Smith

Gotelli³

et al. 2017

PLoS ONE

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ObjectiveAssessment of serum 25-hydroxyvitamin D (25(OH)D) correlations with clinical parameters and evaluation of the efficacy of standard oral supplementation in systemic sclerosis (SSc) patients.Methods154 SSc patients were recruited, in all seasons. Serum 25(OH)D concentrations were evaluated using LIAISON 25-OH (Diasorin, Italy). Medsger disease severity scale (DSS), nailfold videocapillaroscopy (NVC) and all instrumental exam contemplated by international guidelines were performed. Drug assumption, including oral colecalciferol, was evaluated. Non-parametric tests were used for statistical analysis.ResultsAverage 25(OH)D serum concentration was 18.7 ±9 ng/ml (<20 classified as deficiency). A significant correlation was found with presence/absence of lung bi-basal fibrotic changes (16.1 ±8 ng/ml and 20 ±10 ng/ml, respectively; p = 0.04). Peripheral vascular (p = 0.03), kidney (p = 0.02), gastrointestinal (p = 0.05) Medsger’s DSS parameters were found to correlate with 25(OH)D serum concentrations. No significant correlations were observed with digital ulcers incidence, strictly correlated to patterns of microangiopathy, defined at NVC analysis (p<0.0001). Interestingly, no effects of treatment with oral colecalciferol (Dibase 1,000 IU daily for at least 6 months) were found on 25(OH)D serum concentrations in treated (18.8 ±10 ng/ml) or untreated (18.7 ±9 ng/ml) SSc patients (p = 0.81). A significant difference was observed among seasonal 25(OH)D serum concentrations (winter: 14.6 ±7.8 ng/ml, spring: 17.2 ±7.9 ng/ml, summer: 21.43 ±10 ng/ml, autumn: 20.2 ±10 ng/ml; p = 0.032) in all patients.ConclusionSerum 25(OH)D deficiency was found to correlate with lung involvement, peripheral vascular, kidney and gastrointestinal Medsger’s DSS parameters and with seasonality In SSc patients. Supplementation with oral colecalciferol was found not effective in increasing 25(OH)D serum concentrations. Therefore, for successful replacement, supra-physiological vitamin D3 doses or programmed UVB light exposure should be tested.

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Section: Discussioncontrasting

confidence: 74%

Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments

Trombetta¹,

Smith

Gotelli³

et al. 2017

PLoS ONE

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“…In a cohort with systemic sclerosis, levels of 25(OH)vitD above 30 ng/mL had an incidence of echocardiographically elevated mPAP of 5% versus 40% in vitD-deficient patients [48]. In another cohort of patients with systemic sclerosis, subjects with vitD levels <30 ng/mL had higher systolic pulmonary arterial pressure than those with lower levels (34 vs. 25 mmHg) [49].…”

Section: Discussionmentioning

confidence: 96%

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Callejo

Mondéjar-Parreño

Esquivel-Ruiz

et al. 2020

JCM

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Introduction: Epidemiological studies suggest a relationship between vitamin D deficiency and cardiovascular and respiratory diseases. However, whether total, bioavailable, and/or free vitamin D levels have a prognostic role in pulmonary arterial hypertension (PAH) is unknown. We aimed to determine total, bioavailable, and free 25-hydroxy-vitamin D (25(OH)vitD) plasma levels and their prognostic value in PAH patients. Methods: In total, 67 samples of plasma from Spanish patients with idiopathic, heritable, or drug-induced PAH were obtained from the Spanish PH Biobank and compared to a cohort of 100 healthy subjects. Clinical parameters were obtained from the Spanish Registry of PAH (REHAP). Results: Seventy percent of PAH patients had severe vitamin D deficiency (total 25(OH)vitD < 10 ng/mL) and secondary hyperparathyroidism. PAH patients with total 25(OH)vitD plasma above the median of this cohort (7.17 ng/mL) had better functional class and higher 6-min walking distance and TAPSE (tricuspid annular plane systolic excursion). The main outcome measure of survival was significantly increased in these patients (age-adjusted hazard ratio: 5.40 (95% confidence interval: 2.88 to 10.12)). Vitamin D-binding protein (DBP) and albumin plasma levels were downregulated in PAH. Bioavailable 25(OH)vitD was decreased in PAH patients compared to the control cohort. Lower levels of bioavailable 25(OH)vitD (<0.91 ng/mL) were associated with more advanced functional class, lower exercise capacity, and higher risk of mortality. Free 25(OH)vitD did not change in PAH; however, lower free 25(OH)vitD (<1.53 pg/mL) values were also associated with high risk of mortality. Conclusions: Vitamin D deficiency is highly prevalent in PAH, and low levels of total 25(OH)vitD were associated with poor prognosis.

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“…Vitamin D is able to influence the immune response; its role has been proven in different settings and it has been studied also in SSc. In particular, low levels have been reported in the literature with a prevalence of insufficiency even higher than 80% and of deficiency higher than 20% and its deficiency has been related to some disease manifestations, such as poor quality of life, low diffusing capacity for carbon monoxide (DLCO), diastolic dysfunction, digital contractures, advanced skin fibrosis, long disease duration, high values of C‐reactive protein and erythrocyte sedimentation rate, high pulmonary arterial pressure at echocardiography, lung involvement, kidney and gastrointestinal Medsger's severity score parameters and high disease activity . In particular, an association with microvascular involvement has been found as shown by the link with avascular areas at nailfold videocapillaroscopy (NVC), peripheral vascular Medsger's severity score parameters and DU development .…”

Section: Introductionmentioning

confidence: 99%

Vitamin D serum levels and the risk of digital ulcers in systemic sclerosis: A longitudinal study

et al. 2019

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Aim: Low levels of vitamin D (25OHD) have been found to associated with digital ulcers (DUs) in systemic sclerosis (SSc), although only cross-sectional studies have been performed. We aimed to investigate if variations in vitamin D serum levels over time affect DU in SSc. Methods: This is a retrospective study on 65 patients. 25OHD was measured in 2011 and 2016 and its variations correlated with DU. Results: The mean age of our cohort was 58 (SD 12) years with a mean disease duration of 9.5 (5.3) years. Most of our patients had a limited SSc (69.2%). At baseline 50.8% and 41.5% after 5 years had 25OHD <30 ng/mL. Patients receiving supplementation (8750 IU/wk) at baseline numbered 39 (60.0%) and 45 (69.2%) at the end of follow up. Nevertheless, 31 (47.7%) had a decrease of 25OHD in 5 years. In univariate analysis, patients with incident DU had a decrease in 25OHD as compared to patients with no incident DU (−17.4 [37.0] vs 13.0 [89.5], P = 0.018). No differences in 25OHD variations were found for other disease characteristics. In multivariate analysis correcting for previous DU and modified Rodnan Skin Score at baseline, patients with a decrease in 25OHD had an increased risk of developing DU (odds ratio 16.6;95% CI 1.7-164.5, P = 0.017). Conclusions:A decrease in 25OHD is associated with the risk of developing DUs. In addition, vitamin D supplementation with the doses currently recommended may be insufficient in SSc. Further studies in wider cohorts are needed to confirm these results. K E Y W O R D Sdigital ulcers, supplementation, systemic sclerosis, vitamin D

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Low vitamin D status in systemic sclerosis and the impact on disease phenotype

Cited by 38 publications

References 36 publications

Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments

Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments

Total, Bioavailable, and Free Vitamin D Levels and Their Prognostic Value in Pulmonary Arterial Hypertension

Vitamin D serum levels and the risk of digital ulcers in systemic sclerosis: A longitudinal study

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