Very low levels of vitamin D in systemic sclerosis patients

Abstract

Vitamin D displays many extraosseous immunomodulatory effects. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis (SSc) and to analyze the associations between the concentration of the vitamin and clinical manifestations. In March-April 2009, 65 consecutive SSc patients underwent evaluation of vitamin D concentrations by the LIAISON immunoassay (normal 30-100 ng/ml). Serum levels between 10 and 30 ng/ml were classified as vitamin D insufficiency, while concentrations <10 ng/ml as vitamin D deficiency. None of the patients were receiving vitamin D supplementation at the time of or during the year prior to study entry. The mean level of vitamin D was 15.8 ± 9.1 ng/ml. Only three cases showed normal values; vitamin D insufficiency and deficiency were found in 43 and 19 cases, respectively. Patients with vitamin D deficiency showed longer disease duration (13.1 ± 6.8 versus 9.4 ± 5.5 years, P = 0.026), lower diffusing lung capacity for carbon monoxide (63.7 ± 12.4 versus 76.4 ± 20.2, P = 0.014), higher estimated pulmonary artery pressure (28.9 ± 9.9 versus 22.8 ± 10.4, P = 0.037) and higher values of ESR (40 ± 25 versus 23 ± 13 mm/h, P = 0.001) and of CRP (7 ± 7 and 4 ± 2 mg/l, P = 0.004) in comparison with patients with vitamin D insufficiency; moreover, late nailfold videocapillaroscopic pattern was more frequently found (52.6% versus 18.6%, P = 0.013). None of the patients showed evidence of overt mal-absorption. Low levels of vitamin D are very frequent in patients with SSc. Intestinal involvement is not likely the cause of vitamin D deficit; other factors such as skin hyperpigmentation and reduced sun exposition for psychological and social reasons may be implicated. Patients with vitamin D deficiency showed more severe disease in comparison with patients with vitamin D insufficiency, above all concerning lung involvement. Further trials are awaited to determine whether vitamin D could represent a modifiable factor able to interfere with SSc evolution.

Association between hypovitaminosis D and systemic sclerosis: True or fake?

“…Auto-antibodies profile, including anti-topoisomerase antibody I (Scl 70), anti-nuclear antibodies (ANA) and anti-centromere antibodies (ACA), has been reported to be associated with low hormone levels by Vacca et al, but following reports in the same findings failed [9][10][11]; [13][14][15][16][17]. Lately, Carmel et al reported no correlation between antivitamin D antibodies and some clinical features [18].…”

“…Lately, Carmel et al reported no correlation between antivitamin D antibodies and some clinical features [18]. Acute-phase reactant including C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR) were extensively investigated in some studies reviewed [11][12][13][14]. Serum calcium, phosphate and bone turnover metabolism were mostly measured in those papers having BMD or parathyroid hormone (PTH) determination in their study protocol [19][20][21].…”

“…Not surprisingly, the association with pulmonary and gastrointestinal tests have been greatly sought, but inconsistent data have been provided [9,11,13,14,16]; [24][25][26].…”

“…Manifold data [9][10][11][12][13] have been provided about the association between low Vitamin D serum levels and clinical features of disease, but few evidences were found to be concordant. Since understanding the pathogenesis implies advances in therapeutic strategies, it is a need to draw conclusions about the role, true or fake, of the hormone, in promoting the onset of SSc.…”

A vitamin D analog inhibits Th2 cytokine- and TGFβ -induced periostin production in fibroblasts: a potential role for vitamin D in skin sclerosis

“…2 Low serum levels of 25-hydroxyvitamin D3 (25OH-D3) have been reported in patients with SSc. [3][4][5][6] The average concentration of 25OH-D3 was significantly lower in patients with a high degree of skin involvement (Rodnan skin score > 10) compared with patients with low degree of skin involvement (Rodnan skin score 10). 3 The effects of systemic vitamin D supplementation in SSc have been evaluated in some studies, however, the results vary between studies.…”