Juvenile systemic lupus erythematosus (JSLE) is usually associated with vitamin D deficiency and low bone mineral density.
Objectives
To evaluate serum levels of 25-OH vitamin D in JSLE patients and to correlate these findings with disease activity and bone density.
Methods
This study was conducted on 100 patients with JSLE and 100 healthy children as controls. Disease duration and SLEDAI for disease activity were evaluated. CBC, anti-dsDNA, C3,C4,24hr urinary proteins, creatinine, estimated glomerular filtration rate(e-GFR),Ca,P,PTH, 25 (OH) D levels, and bone mineral density(BMD)Z score were measured.
Results
There were significant differences in mean 25(OH)D concentration between patients group (19.37 ± 9.72 ng/ml) and controls 35.90 ± 9.66 ng/ml(p < 0.05), with significant difference between active and inactive patients (p < 0.05).There were significant negative correlations between serum 25(OH)D and SLEDAI (r-0.545, p 0.001), steroid dose (r-0.561, p 0.001), anti-dsDNA (r-0.685, p 0.006), 24 hr-proteinuria (r-0.738, p 0.001) and PTH (r-0.335, p 0.001), significant positive correlations between 25(OH)D and C3 (r0.617, p 0.001),C4 (r0.544, p 0.001) serum Ca (r0.424, p 0.001) and Z score (r0.561, p 0.001),with non-significant correlations between 25(OH)D and serum P and both disease & steroid duration, (p > 0.05).
Conclusion
Vitamin D deficiency is common in JSLE, it’s correlated significantly with disease activity and bone mineral density.
DeborahMLKamphuisS.Systemic lupus erythematosus in children and adolescents. Pediatr Clin North Am2012;
59: 345–364.
2.
HassanalilouTKhaliliLGhavamzadehSShokriAPayahooLKhajeY.Role of vitamin D deficiency in systemic lupus erythematosus incidence and aggravation. Auto Immune Highlights2018;
9: 1.
3.
von SchevenECorbinKJStagiSStefanoSCimazR.Glucocorticoid-associated osteoporosis in chronic inflammatory diseases: epidemiology, mechanisms, diagnosis, and treatment. Curr Osteoporos Rep2014;
12: 289–299.
4.
HolickMF.Vitamin d status: measurement, interpretation and clinical application. Ann Epidemiol2009;
19: 73–78.
5.
SahebariMNabaviNSalehiM.Correlation between serum 25(OH) D values and lupus disease activity: an original article and a systematic review with meta-analysis focusing on serum vit D confounders. Lupus2014;
23: 1164–1177.
6.
ChaiamnuaySChailurkitLNarongroeknawinPAsavatanabodeePLaohajaroensombatSChaiamnuayP.Current daily glucocorticoid use and serum creatinine levels are associated with lower 25(OH) vitamin D levels in Thai patients with systemic lupus erythematosus. JCR2013;
19: 121–125.
7.
LinTCWuJYKuoMLOuLSYehKWHuangJL.Correlation between disease activity of pediatric-onset systemic lupus erythematosus and level of vitamin D in Taiwan: a case cohort study. J Microbiol Immunol Infect2018;
51: 110–114.
8.
CasellaCBSeguroLPCTakayamaLMedeirosDBonfaEPereiraRMR.Juvenile onset systemic lupus erythematosus: a possible role for vitamin D in disease status and bone health. Lupus2012;
21: 1335–1342.
9.
StagiSCavalliLBertiniF, et al.
Vitamin D levels in children, adolescents, and young adults with juvenile-onset systemic lupus erythematosus: a cross-sectional study. Lupus2014;
23: 1059–1065.
10.
HochbergM.Updating the American College of Rheumatology revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1997;
40: 1725.
11.
BertsiasGKIoannidisJPAringerM, et al.
EULAR recommendations for the management of systemic lupus erythematosus with neuropsychiatric manifestations: report of a task force of the EULAR standing committee for clinical affairs. Ann Rheum Dis2010;
69: 2074–2082.
12.
WieldersJPWijnbergFA.Preanalytical stability of 25(OH)—vitamin D3 in human blood or serum at room temperature: solid as a rock. Clin Chem2009;
55: 1584–1588.
13.
WeeningJJD’AgatiVDSchwartzMM, et al.
The classification of glomerulonephritis in systemic lupus erythematosus. J Am SocNephrol2004;
15: 241–250.
14.
RauchFPlotkinHDiMeglioL, et al.
Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2007 pediatric official positions. J Clin Densitom2008;
11: 22–28.
15.
BonakdarZSJahanshahifarLJahanshahifarFGholamrezaeiA.Vitamin D deficiency and its association with disease activity in new cases of systemic lupus erythematosus. Lupus2011;
20: 1155–1160.
16.
BogaczewiczJSysa-JedrzejowskaAArkuszewskaC, et al.
Vitamin D status in systemic lupus erythematosus patients and its association with selected clinical and laboratory parameters. Lupus2012;
21: 477–484.
17.
SumethkulKBoonyaratavejSKitumnuaypongT, et al.
The predictive factors of low serum 25-hydroxyvitamin D and vitamin D deficiency in patients with systemic lupus erythematosus. Rheumatol Int2013;
33: 1461–1467.
18.
Abou-RayaAAbou-RayaSHelmiiM.The effect of vitamin D supplementation on inflammatory and hemostatic markers and disease activity in patients with systemic lupus erythematosus: a randomized placebo-controlled trail. J Rheumatol2013;
40: 265–272.
19.
SenDKeenR.Osteoporosis in systemic lupus erythematosus: prevention and treatment. Lupus2001;
10: 227–232.
20.
RobinsonABThierry-PalmerMGibsonKLRabinovichCE.Disease activity, proteinuria, and vitamin D status in children with systemic lupus erythematosus and juvenile dermatomyositis. J Pediatr2012;
160: 297–302.
21.
CutoloMOtsaK.Review: vitamin D, immunity and lupus. Lupus2008;
17: 6–10.
22.
KamenDLCooperGSBoualiHShaftmanSRHollisBWGilkesonGS.Vitamin D deficiency in systemic lupus erythematosus. Autoimmune Rev2006;
5: 114–117.
23.
ChenSSimsGPChenXXGuYYChenSLipskyPE.Modulatory effects of 1, 25-dihydroxyvitamin D3 on human B cell differentiation. J Immunol2007;
179: 1634–1647.
24.
OrbachHZandman-GoddardGAmitalH, et al.
Novel biomarkers in autoimmune diseases: prolactin, ferritin, vitamin D, and TPA levels in autoimmune diseases. Ann N Y Acad Sci2007;
1109: 385–400.
25.
Ruiz-IrastorzaGEgurbideMVOlivaresNMartinez-BerriotxoaAAguirreC.Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford)2008;
47: 920–923.
26.
ZoldEBartaZBodolayE.Vitamin D deficiency and connective tissue disease. Vitam Horm2011;
86: 261–286.
27.
GatenbyPLucasRSwaminathanA.Vitamin D deficiency and risk for rheumatic diseases: an update. Curr Opin Rheumatol2013;
25: 184–191.
28.
ArnsonYAmitalHShoenfeldY.Vitamin D and autoimmunity: new etiological and therapeutic considerations. Ann Rheum Dis2007;
66: 1137–1142.
29.
SchneiderL, dos Santos AS, Santos M, da Silva Chakr RM and Monticielo OA.
Vitamin D and systemic lupus erythematosus: state of the art. Clin Rheumatol2014;
33: 1033–1040.
30.
RitterhouseLLCroweSRNiewoldTB, et al.
Vitamin D deficiency is associated with an increased autoimmune response in healthy individuals and in patients with systemic lupus erythematosus. Ann Rheum Dis2011;
70: 1569–1574.
31.
StagiSCavalliLBertiniFMatucci CerinicMLuisa BrandiMFalciniF.Cross-sectional and longitudinal evaluation of bone mass and quality in children and young adults with juvenile onset systemic lupus erythematosus (JSLE): role of bone mass determinants analyzed by DXA, PQCT and QUS. Lupus2014;
23: 57–68.
32.
TrapaniSCivininiRErminiMPaciEFalciniF.Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density. Rheumatol Int1998;
18: 45–49.
33.
Mir SadatAAbdulmohsenHHaifaAAAl-MulhimFAAl-AliAK.Influence of vitamin D levels on bone mineral density and osteoporosis. Ann Saudi Med2011;
31: 602–608.
34.
KotaSJammulaSKotaSMeherLModiK.Correlation of vitamin D, bone mineral density and parathyroid hormone levels in adults with low bone density. Indian J Orthop2013;
47: 402–408.
35.
VasundharaKAkkenapallyPLRamathulasiK.Association between serum 25-hydroxyvitamin D levels and bone mineral density in normal postmenopausal women. J Midlife Health2016;
7: 163–168.
36.
GhannamNNHammamiMMBakheetSMKhanBA.Bone mineral density of the spine and femur in healthy Saudi females: relation to vitamin D status, pregnancy, and lactation. Calcif Tissue Int1999;
65: 23–30.
37.
NakamuraKTsugawaNSaitoT, et al.
Vitamin D status, bone mass, and bone metabolism in home-dwelling postmenopausal Japanese women: Yokogoshi study. Bone2008;
42: 271–278.
38.
ZhenDLiuLGuanCZhaoNTangX.High prevalence of vitamin D deficiency among middle-aged and elderly individuals in northwestern China: its relationship to osteoporosis and lifestyle factors. Bone2015;
71: 1–6.
39.
RassouliAMilanianIMoslemi-ZadehM.Determination of serum 25-hydroxyvitamin D 3 levels in early postmenopausal Iranian women: relationship with bone mineral density. Bone2001;
29: 428–430.
