Prevalence and predictors of vitamin D insufficiency in supplemented and non-supplemented women with systemic lupus erythematosus in the Mediterranean region

Abstract

It has been previously reported that vitamin D deficiency is more prevalent among SLE patients than in the general population. We sought to determine the prevalence of vitamin D insufficiency and deficiency and their related factors, its relationship to SLE symptoms and disease activity on a group of supplemented and non-supplemented female SLE patients from the Mediterranean region. We performed a cross-sectional study including female SLE patients who regularly attended the outpatient Lupus Unit at Parc de Salut Mar-IMAS in Barcelona, from January 2012 to May 2014. Collected data were sociodemographics, vitamin D supplementation, fatigue degree visual analog scale, pharmacological treatment, main SLE serological markers, indexes, scales and plasma levels of 25-hydroxyvitamin D. One hundred and two consecutive female SLE patients were included. Vitamin D overall insufficiency and deficiency were exhibited by 46 and 22.5 % of patients, respectively. Vitamin D insufficiency was found in 50 % of supplemented and 60 % of non-supplemented patients. Among non-supplemented female SLE patients, it was found that patients with vitamin D insufficiency showed more fatigue (p = 0.009) and received more oral corticosteroids (p = 0.02) than those with normal levels. Patients with vitamin D insufficiency (supplemented and non-supplemented) received more oral corticosteroids than those without insufficiency (p = 0.008). Vitamin D insufficiency is highly prevalent among female SLE patients, even in southern regions. Non-supplemented female SLE patients showed more fatigue and received more oral corticosteroids than those with normal levels of vitamin D. These data were not found in supplemented patients although having a high prevalence of vitamin D insufficiency (up to 50 %). Further studies with longer follow-up and larger population are needed to confirm our observations.

25‐Hydroxyvitamin D concentrations and risk of metabolic syndrome in systemic lupus erythematosus women

“…In our SLE patients with low disease activity, the frequency of low (deficiency or insufficiency) vitamin D was very high (90%) despite of the high rate of vitamin D supplementation, as previously described in this population . However, the prevalence of MetS was 49.3%, higher than in reports of other SLE cohorts …”

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

“…Fatigue is one of the most common symptoms described by patients affected by SLE, being present in around 80% of all lupus patients and conferring disability in more than half of patients [152]. Vitamin D deficiency has been reported in several studies as a factor associated with fatigue in SLE, even when no other clinical correlations were found [48,104,133,153]. Salman-Monte et al, for instance, have recently shown that non-supplemented SLE female patients with insufficient vitamin D levels had significantly higher fatigue compared to subjects with normal vitamin D serum ranges [104].…”

“…Vitamin D deficiency has been reported in several studies as a factor associated with fatigue in SLE, even when no other clinical correlations were found [48,104,133,153]. Salman-Monte et al, for instance, have recently shown that non-supplemented SLE female patients with insufficient vitamin D levels had significantly higher fatigue compared to subjects with normal vitamin D serum ranges [104]. Moreover, increased 25(OH)D3 levels secondary to supplementation seem to have a favourable influence on fatigue as suggested by the significant inverse correlation between changes in vitamin D levels and differences in the VAS fatigue score post-supplementation [133].…”

The Impact of Vitamin D on the Immunopathophysiology, Disease Activity, and Extra-Musculoskeletal Manifestations of Systemic Lupus Erythematosus

“…Up to 80% of patients with SLE report symptoms of fatigue during their disease course [95]. Fatigue in SLE patients has been found to be related to low serum vitamin D levels [95,96,97,98,99]. A cross-sectional study of 90 patients with SLE found that those with vitamin D deficiency (25-(OH)D 3 ≤10 ng/mL) reported higher fatigue scores that those with adequate vitamin D levels [100].…”

“…In the most updated meta-analysis of the three studies, which involved 233 patients in the vitamin D treatment group and 128 in the placebo group, vitamin D supplementation was found to be significantly associated with a reduction in anti-dsDNA positivity ( p = 0.005), without statistically significant heterogeneity amongst the studies [110]. Furthermore, the vitamin D supplement led to a reduction in fatigue [98,104], decrease in the Th1/Th17 and memory B cells that would otherwise enhance lupus-related inflammation, and increase in Treg cells that dampen lupus-related proinflammatory response [48,104]. While the presence of the type 1-IFN signature has recently been implicated in active SLE, vitamin D supplementation however failed to demonstrate a significant change in the IFN signature after 12-weeks of treatment [105].…”