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Lupus Sci Med. 2014 Jun 7;1(1):e000027. doi: 10.1136/lupus-2014-000027. eCollection 2014.

Lower vitamin D levels are associated with higher systemic lupus erythematosus activity, but not predictive of disease flare-up.

Author information

1
UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Médecine Interne 1, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France.
2
UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Centre de référence national pour le Lupus Systémique et le syndrome des Antiphospholipides, Service de Médecine Interne 2, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France.
3
AP-HP, Hôpital Pitié-Salpêtrière, Unité de recherche clinique, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France.
4
AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire d'Immunochimie, 47-83 Boulevard de l'Hôpital , Paris, Cedex , France.
5
Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Saint-Louis, Service d'Immunologie Clinique, 1 avenue Claude Vellefaux , Paris , France.
6
Université de Clermont-Ferrand , Clermont-Ferrand , France ; CHU Clermont-Ferrand, Hôpital Gabriel Montpied, service de Médecine Interne , Clermont-Ferrand, Cedex , France.
7
UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Tenon, Service de Dermatologie Allergologie , Paris , France.
8
Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Cochin, Service de Médecine Interne , Paris , France.
9
Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Lariboisière, Service de Rhumatologie , Paris , France.
10
CHU Amiens, Hôpital Nord, Service de Médecine Interne, Place Victor Pauchet , Amiens , France.
11
AP-HP, Hôpital Henri Mondor, Service de Médecine Interne , Créteil , France.
12
Hospices Civils de Lyon, Groupement Hospitalier Edouard Herriot, Service de Médecine Interne , Lyon , France.
13
Université Versailles-Saint-Quentin-en-Yvelines, Hôpital Foch, Service de Médecine Interne , Suresnes, Cedex , France.
14
Université Paul-Sabatier , Toulouse , France ; CHU Toulouse, Hôpital Purpan, Service de Médecine Interne, Place Dr Baylac , Toulouse , France.
15
Université Paris Diderot, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Bichat Claude-Bernard, Service de Médecine Interne , Paris , France.
16
Université Paris Nord , Sorbonne Paris Cité , France ; AP-HP, Hôpital Jean-Verdier, Service de Médecine Interne , Bondy , France.
17
UPMC, Université Paris 6 , Paris , France ; AP-HP, Hôpital Pitié-Salpêtrière, Service de Pharmacologie , Paris, Cedex , France.
18
Université Paris Descartes, Sorbonne Paris Cité , Paris , France ; AP-HP, Hôpital Necker-Enfants Malades, Laboratoire de Physiologie , Paris , France.

Abstract

OBJECTIVES:

Growing evidence suggests that vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases, including systemic lupus erythematosus (SLE). Recent studies have found an association between lower serum 25-hydroxyvitamin D (25(OH)D) levels and higher SLE activity. We studied the relationship between 25(OH)D levels and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and we assessed for the first time the role of vitamin D in predicting SLE flare-ups.

METHODS:

Serum 25(OH)D levels were measured in 170 patients with SLE who were prospectively followed up for 6 months (Plaquenil LUpus Systemic study, ClinicalTrials.gov number NCT00413361).

RESULTS:

The mean SLEDAI score was 2.03±2.43 and 12.3% patients had active disease (SLEDAI ≥6). The mean 25(OH)D level was 20.6±9.8 ng/mL. Deficiency (25(OH)D <10 ng/mL) was observed in 27 (15.9%), insufficiency (10≤25(OH)D<30) in 112 (65.9%) and optimal vitamin D status (25(OH)D≥30) in 31 (18.2%) patients. In multivariate analysis, female gender (p=0.018), absence of defined antiphospholipid syndrome (p=0.002) and higher creatinine clearance (p=0.004) were predictive of lower 25(OH)D levels. In multivariate analysis, lower 25(OH)D levels were associated with high SLE activity (p=0.02). Relapse-free survival rate was not statistically different according to the vitamin D status during the 6-month follow-up (p=0.22).

CONCLUSIONS:

We found a low vitamin D status in the majority of patients with SLE, and a modest association between lower 25(OH)D levels and high disease activity. There was no association between baseline 25(OH)D levels and relapse-free survival rate.

KEYWORDS:

Autoimmune Diseases; Systemic Lupus Erythematosus; hydroxychloroquine; vitamin D

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