Lupus patients are 5 X more likely to have low vitamin D – 3 meta-analysis 2019

Vitamin D Life on Autoimmune Diseases and Lupus

Lupus is an Autoimmune Disease

• Autoimmune diseases associated with low Vitamin D and Vitamin D Receptor – July 2017
• Resveratrol Role in Autoimmune Disease-A Mini-Review. – Dec 2016

Autoimmune category starts with

• 164 items in Autoimmune category
• Vitamin D and   MS    Asthma    RA    Diabetes    Gut   Allergy    Hay Fever    Muscular Dystrophy   Lupus    Psoriasis
• Autoimmune disease clusters run in families having low D
• How Vitamin D reduces inflammation, improves immunity and fights autoimmunity – review Dec 2018
• 120 doctors and 20,000 MS patients using high dose Vitamin D Dec 2018
• Vitamin D has treated Multiple Sclerosis and autoimmune diseases for 16 years – Coimbra April 2018
• Vitamin D Receptor is associated in over 58 autoimmune studies
• Many autoimmune diseases associated with low vitamin D or poor Vit D genes – July 2019
  

Lupus

• Impact of Vitamin D on Lupus – Aug 2018
• Lupus associated with low vitamin D – Caucasian 2.2 X, Arab 4.6 X – meta-analysis Jan 2018
• Lupus reduced by Vitamin D for all trials longer than 12 weeks - review Sept 2017
• Lupus flareups cut in half by just 2,000 IU of vitamin D – RCT Dec 2012
• Lupus is both prevented and treated by Vitamin D – review Dec 2017
• It is time to routinely give vitamin D to Lupus patients – Dec 2016
• Connective tissue disorders (Lupus, RA, etc) treated by vitamin D – May 2016
• If Lupus in family – 5 times more likely to get Lupus if low vitamin D and poor CYP24A1 – June 2016
• Lupus is both prevented and treated by Vitamin D – review Dec 2017
• Lupus category listing has 61 items

Intervention studies of Lupus and Vitamin D

6.6 X Jan 2019

Decreased serum/plasma vitamin D levels in SLE patients: A Meta-analysis.
Curr Pharm Des. 2019 Jan 11. doi: 10.2174/1381612825666190111145848.
Wang XR1, Xiao JP2, Zhang JJ3, Wu YG1.
1 Department of Nephrology, The First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Hefei, Anhui. China.
2 Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui. China.
3 Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui. China.

Background and Objective：The evidence regarding the association between serum/plasma vitamin D (VitD) concentrations and systemic lupus erythematosus (SLE) is inconsistent. The study was based on relevant results from literatures that were identified and evaluated. The aim of this meta-analysis is to determine circulating VitD in SLE patients and explore influencing factors.

Methods：Studies examining VitD levels in SLE patients were identified through targeted searches in the PubMed and EMBASE databases (up to December 2017). Data extracted from eligible studies was synthesized to calculate the standardized mean difference (SMD), odds ratio (OR), and 95% confidence interval (CI). A fixed or a random effects model was applied to calculate the pooled SMDs and ORs depending on heterogeneity across studies.

Results：A total of 24 studies, including 6017 patients and 18,417 controls were included. The pooled analysis suggested that VitD levels were significantly lower in SLE patients compared with those in controls [SMD= -0.09, 95%CI= -0.12 to -0.06, P < 0.001]. When the studies were stratified by ethnicity, VitD concentrations were also significantly lower in Asian, Caucasian and African patients. When the studies were stratified by age, gender, VitD level was lower in patients than that in controls. Subgroup analyses stratified by measurement type (expect for radioimmunoassay) also demonstrated consistent results.
Moreover, VitD insufficiency was more prevalent in SLE patients than healthy controls [OR=6.57, 95%CI=4.64-9.29].

Conclusion: Compared with healthy controls, SLE patients had lower concentration of VitD. Additionally, the prevalence of VitD insufficiency is more common in SLE patients.

4.4 X - Aug 2019

Association between circulating 25-hydroxyvitamin D and systemic lupus erythematosus: A systematic review and meta-analysis.
Int J Rheum Dis. 2019 Aug 30. doi: 10.1111/1756-185X.13676.
Guan SY1,2, Cai HY3, Wang P1,2, Lv TT4, Liu LN1,2, Mao YM1,2, Zhao CN1,2, Wu Q1,2, Dan YL1,2, Sam NB1,2, Wang DG3, Pan HF1,2.

AIM:
The indicators for measuring vitamin D are various, and 25-hydroxyvitamin D (25(OH)D) is considered as the optimal indicator of total vitamin D levels. In this study, we aim to deeply explore the 25(OH)D status in systemic lupus erythematosus (SLE) patients, and evaluate its relation to SLE risk and disease severity.

METHODS:
Literature about 25(OH)D status and its associations with SLE were searched in Pubmed, Embase and Cochrane Library databases. Standardized mean difference (SMD), odds ratio (OR) and corresponding 95% confidence interval (95% CI) were illustrated by forest plots, and correlation coefficients (r) were combined by generic inverse variance method. Heterogeneity and publication bias were quantified by I-squared (I2 ) test, funnel plot and Egger's test, respectively. Sensitivity analyses were further examined by leave-one-out method.

RESULTS:
Nineteen articles were included into our meta-analysis. The overall results showed that compared with the healthy controls, the circulating 25(OH)D levels were significantly lower in SLE patients (pooled SMD = -1.63, 95% CI: -2.51 to -0.76). Subgroup analysis revealed that compared with the healthy controls, SLE patients of Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) ≥ 10, Arab and European ethnicity, all 4 seasons, no vitamin D supplement, had significantly lower circulating 25(OH)D levels; no significant differences were observed in SLE patients of SLEDAI < 10, mixed ethnicity, spring, summer, vitamin D supplement, respectively; no matter the changes of age, disease duration, and the therapy of corticosteroid or immunosuppressive or neither, circulating 25(OH)D levels were significantly reduced in SLE patients. The deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease (not significantly), significantly decrease SLE risk, respectively (pooled OR = 4.37, 95% CI: 1.49 to 12.84; pooled OR = 0.52, 95% CI: 0.22 to 1.26; pooled OR = 0.31, 95% CI: 0.15 to 0.63). Circulating 25(OH)D levels were inversely associated with SLEDAI (pooled correlation coefficient = -0.50, 95% CI: -0.8278 to -0.1689).

CONCLUSIONS:
Compared with healthy controls, 25(OH)D levels are significantly lower in SLE patients, which is influenced by disease activity, ethnicity, seasons and vitamin D supplement; no matter the change of age, diseases duration and therapy of corticosteroid or immunosuppressive or neither, 25(OH)D levels are significantly decreased in SLE patients; the deficiency, insufficiency and sufficiency of vitamin D could significantly elevate, slightly decrease, and significantly decrease SLE risk, respectively; and 25(OH)D levels inversely correlate with SLEDAI.

??X Sept 2019

Vitamin D status in patients with systemic lupus erythematosus (SLE): A systematic review and meta-analysis
Md. AsifulIslamaShahad SaifKhandkerb1Sayeda SadiaAlamb1PrzemysławKotylacRoslineHassana
Autoimmunity Reviews, https://doi.org/10.1016/j.autrev.2019.102392

Highlights

• Significantly low levels of serum vitamin D are observed in SLE patients compared to healthy subjects.
• Latitude, season and medications could be the risk factors in inadequate vitamin D in SLE.
• Vitamin D supplementation with regular monitoring should be considered as part of SLE management plans.
• Vitamin D insufficiency/deficiency in SLE is a cause or consequence, or both is still a matter of debate.

Background
Systemic lupus erythematosus (SLE) is a systemic autoimmune disease where chronic inflammation and tissue or organ damage is observed. Due to various suspected causes, inadequate levels of vitamin D (a steroid hormone with immunomodulatory effects) has been reported in patients with SLE, however, contradictory.

Aims
The aim of this systematic review and meta-analysis was to evaluate the serum levels of vitamin D in patients with SLE in compared to healthy controls.

Methods
PubMed, SCOPUS, ScienceDirect and Google Scholar electronic databases were searched systematically without restricting the languages and year (up to March 2, 2019) and studies were selected based on the inclusion criteria. Mean difference (MD) along with 95% confidence intervals (CI) were used and the analyses were carried out by using a random-effects model. Different subgroup and sensitivity analyses were conducted. Study quality was assessed by the modified Newcastle-Ottawa Scale (NOS) and publication bias was evaluated by a contour-enhanced funnel plot, Begg's and Egger's tests.

Results
We included 34 case-control studies (2265 SLE patients and 1846 healthy controls) based on the inclusion criteria.

• Serum levels of vitamin D was detected significantly lower in the SLE patients than that in the healthy controls (MD: −10.44, 95% CI: −13.85 to −7.03; p < .00001).
• SLE patients from Asia (MD: −13.75, 95% CI: −21.45 to −6.05; p = .0005),
• South America (MD: -3.16, 95% CI: −4.62 to −1.70; p < .0001) and
• Africa (MD: −16.15, 95% CI: −23.73 to −8.56; p < .0001);
• patients residing below 37° latitude (MD: −11.75, 95% CI: −15.79 to −7.70; p < .00001);
• serum vitamin D during summer season (MD: -7.89, 95% CI: −11.70 to −4.09; p < .0001),
• patients without vitamin D supplementation (MD: -15.57, 95% CI: −19.99 to −11.14; p < .00001) or
• on medications like hydroxychloroquine, corticosteroids or immunosuppressants without vitamin D supplementation (MD: -16.46, 95% CI: −23.86 to −9.05; p < .0001) are in higher risk in presenting inadequate serum levels of vitamin D.

The results remained statistically significant from different sensitivity analyses which represented the robustness of this meta-analysis. According to the NOS, 91.2% of the studies were considered as of high methodological quality (low risk of bias). No significant publication bias was detected from contour-enhanced and trim and fill funnel plots or Begg's test.

Conclusion
Inadequate levels of serum vitamin D is significantly high in patients with SLE compared to healthy subjects, therefore, vitamin D supplementation with regular monitoring should be considered as part of their health management plans.