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Lapauw B, Laurent MR, Rozenberg S, Body JJ, Bruyère O, Gielen E, Goemaere S, Iconaru L, Cavalier E. When and How to Evaluate Vitamin D Status? A Viewpoint from the Belgian Bone Club. Nutrients 2024; 16:2388. [PMID: 39125269 PMCID: PMC11313844 DOI: 10.3390/nu16152388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/09/2024] [Accepted: 07/11/2024] [Indexed: 08/12/2024] Open
Abstract
Low serum vitamin D levels have been associated with a variety of health conditions which has led the medical community but also the general population to evaluate vitamin D status quite liberally. Nevertheless, there remain questions about the efficacy and cost-effectiveness of such a broad and untargeted approach. This review therefore aims to summarize the current evidence and recommendations on when and how to evaluate vitamin D status in human health and disease. For the general population, most guidelines do not recommend universal screening but suggest a targeted approach in populations at risk. Also, some guidelines do not even recommend evaluating vitamin D status when vitamin D substitution is indicated anyway, such as in children or patients receiving anti-osteoporosis drugs. In those guidelines that recommend the screening of vitamin D status, serum 25(OH)D levels are universally proposed as the preferred screening tool. However, little attention is given to analytical considerations and almost no guidelines discuss the timing and frequency of screening. Finally, there is the known variability in diagnostic thresholds for defining vitamin D insufficiency and deficiency. Overall, the existing guidelines on the evaluation of vitamin D status differ broadly in screening strategy and screening implementation, and none of these guidelines discusses alternative screening modes, for instance, the vitamin metabolic ratio. Efforts to harmonize these different guidelines are needed to enhance their efficacy and cost-effectiveness.
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Affiliation(s)
- Bruno Lapauw
- Department of Endocrinology, Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9052 Ghent, Belgium;
- Department of Internal Medicine and Pediatrics, Ghent University, 9052 Ghent, Belgium
| | - Michaël R. Laurent
- Geriatrics Department, Imelda Hospital, 2820 Bonheiden, Belgium
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, 3000 Leuven, Belgium;
| | - Serge Rozenberg
- Department of Obstetrics and Gynecology, CHU St Pierre, Brussels & Université Libre de Bruxelles, 1000 Bruxelles, Belgium;
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium; (J.-J.B.); (L.I.)
| | - Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, Department of Sport and Rehabilitation Sciences, University of Liège, 4000 Liège, Belgium;
| | - Evelien Gielen
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, 3000 Leuven, Belgium;
- Geriatrics & Gerontology, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Stefan Goemaere
- Department of Endocrinology, Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, 9052 Ghent, Belgium;
- Department of Internal Medicine and Pediatrics, Ghent University, 9052 Ghent, Belgium
| | - Laura Iconaru
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium; (J.-J.B.); (L.I.)
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CIRM, CHU de Liège, 4000 Liège, Belgium;
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Zamani B, Taghvaee F, Akbari H, Mohtashamian A, Sharifi N. Effects of Selenium Supplementation on the Indices of Disease Activity, Inflammation and Oxidative Stress in Patients with Rheumatoid Arthritis: a Randomized Clinical Trial. Biol Trace Elem Res 2024; 202:1457-1467. [PMID: 37477848 DOI: 10.1007/s12011-023-03782-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/14/2023] [Indexed: 07/22/2023]
Abstract
The aim of study was to evaluate the effect of selenium supplementation on disease activity, inflammation, and oxidative stress in patients with rheumatoid arthritis (RA). This study was a randomized double-blind placebo-controlled trial on 59 patients with RA. Participants were randomly divided to receive 200 μg/day of selenium or a placebo for 12 weeks. The disease activity score (DAS.CRP and DAS.ESR), erythrocyte sedimentation rate (ESR), serum levels of C-reactive protein (CRP), fasting blood glucose, lipids, antibodies to cyclic citrullinated protein (anti-CCP), nitric oxide, glutathione, and total antioxidant capacity were assessed. The mean of DAS.CRP and DAS.ESR decreased significantly within both study groups after the intervention. However, the between-group comparisons revealed no significant differences. The CRP levels decreased significantly in the selenium group, and this decrease was near the significance level compared to the placebo (P = 0.05). However, after adjusting for baseline values, the observed difference between groups did not remain significant. In addition, the values of ESR and anti-CCP decreased significantly within the selenium group. Although, between-group comparison did not statistically significant, the change in ESR and anti-CCP in the selenium group was small clinically relevant compared to the placebo [the effect size (95% CI) for ESR: 0.38 (- 0.14, 0.89), and for anti-CCP: 0.32 (- 0.2, 0.83)]. Our study showed that selenium caused a small clinically relevant improvement in some RA biomarkers such as ESR and anti-CCP. Future studies that evaluate the effects of novel forms of supplements such as selenium nanoparticles on the clinical symptoms and biomarkers of RA are suggested. Trial Registration: At www.irct.ir as IRCT20190924044869N1 on 2020-06-14.
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Affiliation(s)
- Batool Zamani
- Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Fereshteh Taghvaee
- Department of Internal Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Hossein Akbari
- Department of Epidemiology and Biostatistics, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Abbas Mohtashamian
- Student Research Committee, Department of Nutrition, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Nasrin Sharifi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Basic Science Research Institute, Kashan University of Medical Sciences, Kashan, Iran.
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Khabbazi A, Mahmoudi M, Esalatmanesh K, Asgari-Sabet M, Safary A. Vitamin D Status in Palindromic Rheumatism: A Propensity Score Matching Analysis. Lab Med 2024; 55:45-49. [PMID: 37204153 DOI: 10.1093/labmed/lmad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
OBJECTIVE To determine whether there is a correlation between vitamin D levels and palindromic rheumatism (PR) as an at-risk phenotype of rheumatoid arthritis (RA). METHODS A total of 308 participants were enrolled in this cross-sectional study. We recorded their clinical characteristics and performed propensity-score matching (PSM). Serum 25(OH)D3 levels were determined via enzyme-linked immunosorbent assay. RESULTS Our PSM resulted in 48 patients with PR and 96 matched control individuals. The multivariate regression analysis we performed after the PSM did not show a significant increase in PR risk in patients with vitamin D deficiency/insufficiency. There was no significant correlation between levels of 25(OH)D3 and frequency/duration of attacks, number of joints affected, and duration of symptoms before diagnosis (P ≥ .05). Mean (SD) serum levels of 25(OH)D3 in patients with and without progression to RA were 28.7 (15.9) ng/mL and 25.1 (11.4) ng/mL, respectively. CONCLUSION Based on the results, we found no clear association between vitamin D serum levels and the risk, severity, and rate of PR progressing into RA.
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Affiliation(s)
- Alireza Khabbazi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Mahmoudi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Esalatmanesh
- Department of Internal Medicine, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Masoomeh Asgari-Sabet
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Azam Safary
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Ghaseminejad-Raeini A, Ghaderi A, Sharafi A, Nematollahi-Sani B, Moossavi M, Derakhshani A, Sarab GA. Immunomodulatory actions of vitamin D in various immune-related disorders: a comprehensive review. Front Immunol 2023; 14:950465. [PMID: 37520529 PMCID: PMC10379649 DOI: 10.3389/fimmu.2023.950465] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
For many years, vitamin D has been acknowledged for its role in maintaining calcium and phosphate balance. However, in recent years, research has assessed its immunomodulatory role and come up with conflicting conclusions. Because the vitamin D receptor is expressed in a variety of immune cell types, study into the precise role of this molecule in diseases, notably autoimmune disorders, has been made possible. The physiologically activated version of vitamin D also promotes a tolerogenic immunological condition in addition to modulating innate and acquired immune cell responses. According to a number of recent studies, this important micronutrient plays a complex role in numerous biochemical pathways in the immune system and disorders that are associated with them. Research in this field is still relatively new, and some studies claim that patients with severe autoimmune illnesses frequently have vitamin D deficiencies or insufficiencies. This review seeks to clarify the most recent research on vitamin D's immune system-related roles, including the pathophysiology of major disorders.
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Affiliation(s)
| | - Ali Ghaderi
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Sharafi
- Students Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Moossavi
- Nanobiology and Nanomedicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Derakhshani
- Laboratory of Experimental Pharmacology, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Gholamreza Anani Sarab
- Cellular and Molecular Research Committee, Birjand University of Medical Sciences, Birjand, Iran
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Vitamin D status and risk of rheumatoid arthritis: systematic review and meta-analysis. BMC Rheumatol 2023; 7:3. [PMID: 36918989 PMCID: PMC10015722 DOI: 10.1186/s41927-023-00325-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/15/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Vitamin D is important for immunomodulation and may play a role in autoimmune diseases. Studies have reported a high prevalence of vitamin D deficiency in rheumatoid arthritis (RA) patients, and vitamin D status, assessed by circulating 25-hydroxyvitamin D [25(OH)D] concentration, is inversely associated with RA disease activity. However, it is unclear whether vitamin D deficiency increases the risk of later developing RA. We conducted a systematic review and meta-analysis of pre-diagnostic 25(OH)D concentrations and risk of RA. METHODS Medline and Embase databases were searched in December 2021 using various keywords for 'vitamin D', 'rheumatoid arthritis', and 'prospective study'. Publications identified from the search were screened for eligibility, studies were excluded if vitamin D status was measured at or after RA diagnosis, and data were extracted from relevant articles. Bayesian meta-analysis was used to estimate the summary relative risk (RR) and 95% credible interval (CrI) for risk of RA in relation to circulating 25(OH)D concentrations, as well as the between-study heterogeneity. RESULTS The search strategy yielded 908 records, of which 4 publications reporting on 7 studies, involving a total of 15,604 participants and 1049 incident RA cases, were included in the meta-analysis. There was no suggestion of an association between 25(OH)D concentration and subsequent risk of RA. The pooled RR per 25 nmol/L increment in 25(OH)D was 0.96 (95% CrI 0.82-1.13; I2 = 52%). No associations were evident in men (RR = 1.02, 95% CrI 0.65-1.61; I2 = 77%, 2 studies) or women (RR = 0.94, 95% CrI 0.73-1.22; I2 = 71%, 4 studies). CONCLUSIONS This systematic review and meta-analysis did not identify evidence of an association between 25(OH)D and RA risk, but there was notable between-study heterogeneity and a lack of precision. Investigations in large-scale prospective studies with long follow-up or suitably designed Mendelian randomisation studies with consideration of potential non-linear relationships are needed to determine whether vitamin D is involved in RA aetiology.
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Nguyen AD, McMahan ZH, Volkmann ER. Micronutrient Deficiencies in Systemic Sclerosis: A Scoping Review. Open Access Rheumatol 2022; 14:309-327. [PMID: 36571105 PMCID: PMC9769137 DOI: 10.2147/oarrr.s354736] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/15/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose The primary aim is to identify the micronutrient deficiencies commonly reported in SSc. The exploratory aim is to evaluate associations between micronutrient deficiencies and SSc clinical manifestations. Patient and Methods We conducted a scoping review of all published reports on SSc and nutrition in PubMed from its inception to August 2020. Clinical trials, observational studies, meta-analyses, and case series (with ≥20 cases) containing data on nutritional deficiency and SSc were included. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for reporting our findings. Two reviewers (ADN and ERV) studied the titles and abstracts of all search results with pre-specified inclusion and exclusion criteria. Results Among 790 retrieved publications, 35 full-length articles and 3 abstracts met the inclusion/exclusion criteria. Included studies took place across multiple geographic locations and included patients with both diffuse and limited cutaneous SSc. Vitamin D deficiency was the most commonly reported deficiency described in SSc, followed by vitamin B12, vitamin B9, selenium, zinc, and iron. In addition, some small studies found deficiencies in vitamins B1, B6, C, E, and A. While some studies reported associations between specific micronutrient deficiencies and SSc disease features (eg, interstitial lung disease was commonly associated with vitamin D deficiency and elevated homocysteine [Hcy]), the evidence to support these associations was not robust. Conclusion Micronutrient deficiencies are common in SSc and are associated with specific SSc features. Routine screening for micronutrient deficiencies may lead to early detection of malnutrition. Future studies are needed to understand how interventions to replete micronutrient deficiencies affect patient outcomes in SSc.
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Affiliation(s)
- Audrey D Nguyen
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Zsuzsanna H McMahan
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth R Volkmann
- Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA,Correspondence: Elizabeth R Volkmann, Division of Rheumatology, Department of Medicine, David Geffen School of Medicine at UCLA, 1000 Veteran Ave, Ste 32-59, Los Angeles, CA, 90095, USA, Tel +1 310-825-2448, Email
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Jiao H, Acar G, Robinson GA, Ciurtin C, Jury EC, Kalea AZ. Diet and Systemic Lupus Erythematosus (SLE): From Supplementation to Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11895. [PMID: 36231195 PMCID: PMC9565311 DOI: 10.3390/ijerph191911895] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease characterised by immune dysregulation affecting multiple organs. Current anti-inflammatory treatments used in SLE are associated with unwanted side-effects. Dietary supplementation has been suggested as a safe and effective addition to conventional treatment, but evidence of efficacy in SLE or preventing associated comorbidities is uncertain. METHODS We identified literature on clinical trials focused on nutritional interventions in SLE aiming to improve inflammation and comorbidities. A systematic-type search on Embase, Medline, and the Cochrane Library, was conducted to identify nutritional interventions among SLE patients in the past 15 years that met our inclusion criteria. RESULTS We identified 2754 articles, of which 14 were eligible for inclusion based on our set criteria and were subsequently quality assessed. Vitamin D or E supplementation was associated with respective improvement of inflammatory markers or antibody production, but not disease activity scores in most studies. Despite their expected synergistic actions, the addition of curcumin on vitamin D supplementation had no additional effects on disease activity or inflammatory markers. Trials of omega-3 fatty acid supplementation presented significant reductions in ESR, CRP, disease activity, inflammatory markers, and oxidative stress, and improved lipid levels and endothelial function, while a low glycaemic index (GI) diet showed evidence of reduced weight and improved fatigue in patients. CONCLUSIONS Different dietary guidelines can therefore be implicated to target specific SLE symptoms or therapeutic side-effects. This systematic review highlights the scarcity of larger and longer in duration trials with homogenous methodologies and verifiable outcomes to assess disease progression.
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Affiliation(s)
- Hanxiao Jiao
- Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - Gizem Acar
- Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
| | - George A. Robinson
- Centre for Rheumatology Research, Division of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
- Centre for Adolescent Rheumatology versus Arthritis, Division of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology versus Arthritis, Division of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Elizabeth C. Jury
- Centre for Rheumatology Research, Division of Medicine, University College London, Rayne Building, London W1CE 6JF, UK
| | - Anastasia Z. Kalea
- Division of Medicine, University College London, Rayne Building, London WC1E 6JF, UK
- Institute of Cardiovascular Science, University College London, London WC1E 6DD, UK
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Scott J, Havyarimana E, Navarro-Gallinad A, White A, Wyse J, van Geffen J, van Weele M, Buettner A, Wanigasekera T, Walsh C, Aslett L, Kelleher JD, Power J, Ng J, O'Sullivan D, Hederman L, Basu N, Little MA, Zgaga L. The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset. Arthritis Res Ther 2022; 24:147. [PMID: 35717248 PMCID: PMC9206351 DOI: 10.1186/s13075-022-02834-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
Background The aetiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine the relapse risk using only the RKD dataset. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results Residential latitude was positively correlated (OR 1.41, 95% CI 1.14–1.74, p = 0.002) and average vitD-UVB negatively correlated (0.82, 0.70–0.99, p = 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57–0.89, p = 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02834-6.
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Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Enock Havyarimana
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | | | - Arthur White
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jason Wyse
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Jos van Geffen
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Michiel van Weele
- Royal Netherlands Meteorological Institute (KNMI), De Bilt, The Netherlands
| | - Antonia Buettner
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Tamara Wanigasekera
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland
| | - Cathal Walsh
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Louis Aslett
- Department of Mathematical Science, University of Durham, Durham, UK
| | - John D Kelleher
- School of Computer Science, Technological University Dublin, Dublin, Ireland
| | - Julie Power
- Vasculitis Ireland Awareness, Galway, Ireland
| | - James Ng
- Department of Statistics, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Declan O'Sullivan
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Lucy Hederman
- ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland
| | - Neil Basu
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity College Dublin, The University of Dublin, Trinity Translational Medicine Institute, St. James's Street, Dublin 8, Ireland. .,ADAPT Centre for Digital Content, Trinity College Dublin, Dublin, Ireland.
| | - Lina Zgaga
- Department of Public Health and Primary Care, Trinity College Dublin, The University of Dublin, Dublin, Ireland
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Ross E, Abulaban K, Kessler E, Cunningham N. Non-pharmacologic therapies in treatment of childhood-onset systemic lupus erythematosus: A systematic review. Lupus 2022; 31:864-879. [PMID: 35442103 DOI: 10.1177/09612033221094704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Childhood-onset systemic lupus erythematosus (cSLE) is a complex multisystem autoimmune disease often associated with pain, fatigue, and mood-related disturbances. cSLE is associated with increased disease severity and higher rates of mortality as compared to adult onset SLE. Therefore, a multi-faceted approach to care, including the use of non-pharmacologic therapies, is essential to ensure optimal patient outcomes. The use of non-pharmacologic therapies as adjunctive treatments has been shown to be beneficial in adults with SLE, yet, their use and effect is less well understood in cSLE. This is the first systematic review to explore the use and quality of evidence of non-pharmacologic approaches to treat cSLE. METHODS A literature review was performed using PRISMA guidelines. Studies until March 2021 with participants diagnosed with cSLE were included. The quality of the evidence was graded via OCEBM levels of evidence guidelines and bias assessed using Cochrane guidelines. Completed clinical trials (via clinicaltrials.gov) were also searched to identify unpublished results. RESULTS Eleven published studies consisting of 1152 patients met inclusion criteria for this review, as well as three additional studies with unpublished data on clinicaltrial.gov. Of the published trials, four studies used patient education/support, three studies used dietary supplementation, three used forms of psychotherapy (e.g., Cognitive behavioral therapy), and 1 used aerobic exercise to target the following issues: treatment adherence (n = 3), quality of life (n = 3), fatigue (n = 2), pain (n = 2), depressive symptoms (n = 1), anxiety (n = 1), and health-related outcomes including disease severity (n = 3), cardiovascular disease risk (Cardiovascular disease; n = 3), and muscle function (n = 1). Across investigations, the quality of the evidence based on study design was moderate/low. In terms of potential outcomes, dietary supplementation methods were successful in 2 of 3 studies and were associated with improvements in disease activity and fatigue. Aerobic exercise was effective in decreasing resting heart rate and increasing cardiorespiratory capacity. Patient education/support was related to significantly increased treatment adherence and decreased cardiovascular risk markers. Two of the three studies examining the impact of psychotherapy showed improvements (e.g., in treatment adherence, depression and fatigue). CONCLUSION This review identifies several promising non-pharmacologic therapies to use as adjunctive treatments to traditional pharmacologic regimens in health and mental health-related outcomes in patients with cSLE. Future well controlled clinical trials would be beneficial to more rigorously evaluate the effects of non-pharmacologic therapies in pediatric populations.
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Affiliation(s)
- Elizabeth Ross
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Khalid Abulaban
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Elizabeth Kessler
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,24319Helen DeVos Children's Hospital (Rheumatology), Grand Rapids, MI, USA
| | - Natoshia Cunningham
- 12268Michigan State University College of Human Medicine, Grand Rapids, MI, USA.,Department of Family Medicine, 12268Michigan State University, East Lansing, MI, USA
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Verma S, Chaturvedi V, Ganguly NK, Mittal SA. Vitamin D deficiency: concern for rheumatoid arthritis and COVID-19? Mol Cell Biochem 2021; 476:4351-4362. [PMID: 34453644 PMCID: PMC8401347 DOI: 10.1007/s11010-021-04245-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 08/16/2021] [Indexed: 12/24/2022]
Abstract
Vitamin D is an immunomodulatory hormone with an established role in calcium and phosphate metabolism and skeletal mineralization. Evidence showing its immunological benefits by regulating essential components of the innate and adaptive immune system is prevalent. Vitamin D deficiency is reported worldwide and is thereby found to be associated with various immune-related diseases. Rheumatoid Arthritis and COVID-19 are two such diseases, sharing a similar hyperinflammatory response. Various studies have found an association of lower Vitamin D levels to be associated with both these diseases. However, contrasting data is also reported. We review here the available scientific data on risk factor association and supplementation benefits of Vitamin D in Rheumatoid Arthritis and COVID-19, intending to critically evaluate the literature.
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Affiliation(s)
- Sneha Verma
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
| | - Ved Chaturvedi
- Department of Rheumatology & Clinical Immunology, Sir Ganga Ram Hospital, New Delhi, India
| | - N K Ganguly
- Department of Research, Sir Ganga Ram Hospital, New Delhi, India
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11
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De Martinis M, Allegra A, Sirufo MM, Tonacci A, Pioggia G, Raggiunti M, Ginaldi L, Gangemi S. Vitamin D Deficiency, Osteoporosis and Effect on Autoimmune Diseases and Hematopoiesis: A Review. Int J Mol Sci 2021; 22:ijms22168855. [PMID: 34445560 PMCID: PMC8396272 DOI: 10.3390/ijms22168855] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/30/2022] Open
Abstract
Vitamin D (VD) is essential for bone homeostasis, but it is also involved in pleiotropic effects on various organs and tissues. In adults, VD deficiency can cause or exacerbate osteoporosis and induce osteomalacia. However, every tissue and cell in the body has a VD receptor, including the brain, heart, stomach, pancreas, skin, gonads, and immune cells, and a deficiency may modify the function of these organs. Thus, the wide-ranging actions of VD help to explain why a reduction in VD amount has been correlated with numerous chronic diseases. In fact, VD deficiency increases the risk of osteoporosis and several other diseases and complications characterized by impaired bone metabolisms, such as autoimmune diseases, inflammatory bowel diseases, allergy, endocrinological diseases, hematological malignancies, and bone marrow transplantation. This review aims to investigate the link between VD deficiency, osteoporosis, and its concomitant diseases. Further epidemiological and mechanistic studies are necessary in order to ascertain the real role of hypovitaminosis in causing the reported diseases; however, adequate vitamin supplementation and restoration of metabolic normality could be useful for better management of these pathologies.
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Affiliation(s)
- Massimo De Martinis
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Allegra
- Department of Human Pathology in Adulthood and Childhood “Gaetano Barresi”, Division of Haematology, University of Messina, 98125 Messina, Italy
- Correspondence: ; Tel.: +39-0902-212-364
| | - Maria Maddalena Sirufo
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Alessandro Tonacci
- Clinical Physiology Institute, National Research Council of Italy (IFC-CNR), 56124 Pisa, Italy;
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), 98164 Messina, Italy;
| | - Martina Raggiunti
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Lia Ginaldi
- Department of Life, Health and Environmental Sciences, University of L’Aquila, 67100 L’Aquila, Italy; (M.D.M.); (M.M.S.); (M.R.); (L.G.)
- Allergy and Clinical Immunology Unit, Center for the Diagnosis and Treatment of Osteoporosis, AUSL 04 Teramo, 64100 Teramo, Italy
| | - Sebastiano Gangemi
- Department of Clinical and Experimental Medicine, School and Operative Unit of Allergy and Clinical Immunology, University of Messina, 98125 Messina, Italy;
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Scott J, Hartnett J, Mockler D, Little MA. Environmental risk factors associated with ANCA associated vasculitis: A systematic mapping review. Autoimmun Rev 2020; 19:102660. [PMID: 32947040 DOI: 10.1016/j.autrev.2020.102660] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/29/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (AAV) is a rare multi-system autoimmune disease, characterised by a pauci-immune necrotising small-vessel vasculitis, with a relapsing and remitting course. Like many autoimmune diseases, the exact aetiology of AAV, and the factors that influence relapse are unknown. Evidence suggests a complex interaction of polygenic genetic susceptibility, epigenetic influences and environmental triggers. This systematic mapping review focuses on the environmental risk factors associated with AAV. The aim was to identify gaps in the literature, thus informing further research. METHODS Articles that examined any environmental risk factor in AAV disease activity (new onset disease or relapse) were included. Studies had to make explicit reference to AAV, which includes the 3 clinico-pathological phenotypes (GPA, MPA and EGPA), rather than isolated ANCA-positivity. All articles identified were English-language, full manuscripts involving adult humans (>16 years). There was no restriction on publication date and all study designs, except single case reports, were included. The systematic search was performed on 9th December 2019, using the following databases: EMBASE, Medline (Ovid), Cochrane Library, CINAHL and Web of Science. RESULTS The search yielded a total of 2375 articles. 307 duplicates were removed, resulting in the title and abstract of 2068 articles for screening. Of these, 1809 were excluded. Thus, 259 remained for full-text review, of which 181 were excluded. 78 articles were included in this review. The most notable findings support the role of various pollutants - primarily silica and other environmental antigens released during natural disasters and through farming. Assorted geoepidemiological triggers were also identified including seasonality and latitude-dependent factors such as UV radiation. Finally, infection was tightly associated, but the exact microorganism(s) is not clear - Staphylococcus aureus is the most presently convincing. CONCLUSION The precise aetiology of AAV has yet to be elucidated. It is likely that different triggers, and the degree to which they influence disease activity, vary by subgroup (e.g. ANCA subtype, geographic region). There is a need for more interoperable disease registries to facilitate international collaboration and hence large-scale epidemiological studies, with novel analytical techniques.
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Affiliation(s)
- Jennifer Scott
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - Jack Hartnett
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, School of Medicine, Trinity College Dublin, Ireland
| | - Mark A Little
- Trinity Health Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Ireland; ADAPT Centre, Trinity College Dublin, Ireland.
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13
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Tabra SAA, Abdelnabi HH, Darwish NFM, El-Barbary AM, AbdelGhafar MT, Abu-Zaid MH. Juvenile lupus and serum vitamin D levels: A cross-sectional study. Lupus 2020; 29:1752-1758. [PMID: 32924829 DOI: 10.1177/0961203320957721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND 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.
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14
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Heidari B, Hajian-Tilaki K, Babaei M. Vitamin D Deficiency and Rheumatoid Arthritis: Epidemiological, Immunological, Clinical and Therapeutic Aspects. Mediterr J Rheumatol 2020; 30:94-102. [PMID: 32185348 PMCID: PMC7045965 DOI: 10.31138/mjr.30.2.94] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/08/2019] [Accepted: 04/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background/Aim: Vitamin D displays an immunologic effect which can modulate function of Th17-related cytokines and thereby prevent perpetuation of inflammation in chronic disorders like rheumatoid arthritis (RA). This review aims to conduct a literature review to provide a summary of recent studies addressing the relationship between vitamin D deficiency and RA based on epidemiological, immunological and therapeutic aspects. Methods: PubMed, Scopus and Google scholar were searched for relevant papers published between 2000–2018. Results: Low intake of vitamin D increases the risk of incident RA, and vitamin D deficiency has been shown to be inversely associated with RA activity in most of these studies. However, characteristics of RA and serum vitamin D status differ across the studies. The results of studies on the effect of supplemental vitamin D in RA vary, from no efficacy to significant improvement in disease activity, as well as quality of life. This should be attributed to variations in dosage of vitamin D, duration of treatment, baseline serum vitamin D in RA patients and characteristics of RA across diverse studies. Conclusion: Current data indicate a therapeutic potential for vitamin D in RA. However, further studies are needed to identify an optimal and effective dosage, duration of treatment and patients who will get the best benefit from the treatment.
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Affiliation(s)
- Behzad Heidari
- Mobility Impairment Research Center; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Clinical Research Development Unit of Rouhani Hospital; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Department of Internal Medicine, Division of Rheumatology; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Karimollah Hajian-Tilaki
- Department of Statistics and Epidemiology, School of Medicine; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Mansour Babaei
- Mobility Impairment Research Center; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Clinical Research Development Unit of Rouhani Hospital; Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,Department of Internal Medicine, Division of Rheumatology; Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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15
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Płazińska MT, Czarnywojtek A, Sawicka-Gutaj N, Zgorzalewicz-Stachowiak M, Czarnocka B, Gut P, Karlinska M, Fichna M, Stachowski A, Ruchała M, Krela-Kaźmierczak I, Królicki L. Vitamin D deficiency and thyroid autoantibody fluctuations in patients with Graves' disease - A mere coincidence or a real relationship? Adv Med Sci 2020; 65:39-45. [PMID: 31884304 DOI: 10.1016/j.advms.2019.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 09/07/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this study was to evaluate the association between vitamin D (vitD) and changes in the titers of anti-TSH receptor (TSHR-Abs), antithyroglobulin (Tg-Abs), and antiperoxidase (TPO-Abs) autoantibodies. MATERIALS/METHODS The study involved 269 patients with Graves' disease (GD), divided into four subgroups (1-4), i.e. 65 smokers treated with vitD(+) (1), 76 smokers not treated with vitD(-) (2), 61 non-smokers treated with vitD(+) (3) and 67 non-smokers with vitD(-) (4). All thyroid parameters were analyzed at entry and 1, 3, 6, 9 and 12 months later. RESULTS The titer of TSHR-Abs in group 3 was significantly lower than in groups 1 and 2 across all time points. At 3, 6 and 12 months, the titers of TSHR-Abs were also lower in group 4 compared to groups 1 and 2. At 9 months, the titers in group 3 were lower than in all other groups. There was a significant inverse correlation between baseline levels of vitD and baseline titers of Tg-Abs (in group 1 only), Tg-Abs after 12 months (in group 1 only), TPO-Abs after 12 months (in groups 1 and 3), fT4 (in group 4 only), and a significant positive correlation with TPO-Abs (in group 2 only). VitD levels at 12 months were inversely correlated with Tg-Abs in group 1. CONCLUSIONS VitD measurements in patients with GD, especially smokers with an increased TSHR-Ab titers before 131I therapy, are recommended. Immunological remission is more likely in patients with GD who receive vitD, particularly smokers.
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16
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Chen SJ, Lin GJ, Chen JW, Wang KC, Tien CH, Hu CF, Chang CN, Hsu WF, Fan HC, Sytwu HK. Immunopathogenic Mechanisms and Novel Immune-Modulated Therapies in Rheumatoid Arthritis. Int J Mol Sci 2019; 20:ijms20061332. [PMID: 30884802 PMCID: PMC6470801 DOI: 10.3390/ijms20061332] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 02/17/2019] [Accepted: 03/12/2019] [Indexed: 12/16/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology. It is characterized by the presence of rheumatoid factor and anticitrullinated peptide antibodies. The orchestra of the inflammatory process among various immune cells, cytokines, chemokines, proteases, matrix metalloproteinases (MMPs), and reactive oxidative stress play critical immunopathologic roles in the inflammatory cascade of the joint environment, leading to clinical impairment and RA. With the growing understanding of the immunopathogenic mechanisms, increasingly novel marked and potential biologic agents have merged for the treatment of RA in recent years. In this review, we focus on the current understanding of pathogenic mechanisms, highlight novel biologic disease-modifying antirheumatic drugs (DMRADs), targeted synthetic DMRADs, and immune-modulating agents, and identify the applicable immune-mediated therapeutic strategies of the near future. In conclusion, new therapeutic approaches are emerging through a better understanding of the immunopathophysiology of RA, which is improving disease outcomes better than ever.
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Affiliation(s)
- Shyi-Jou Chen
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Microbiology and Immunology, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Gu-Jiun Lin
- Department of Biology and Anatomy, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Jing-Wun Chen
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Kai-Chen Wang
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei City 112, Taiwan.
- Department of Neurology, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Pai-Tou, Taipei City 112, Taiwan.
| | - Chiung-Hsi Tien
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Chih-Fen Hu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
| | - Chia-Ning Chang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
| | - Wan-Fu Hsu
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Penghu Branch of Tri-Service General Hospital, National Defense Medical Center, No. 90, Qianliao, Magong City, Penghu County 880, Taiwan.
| | - Hueng-Chuen Fan
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Rd., Neihu District, Taipei City 114, Taiwan.
- Department of Pediatrics, Tungs' Taichung MetroHarborHospital, No. 699, Section 8, Taiwan Blvd., Taichung City 435, Taiwan.
| | - Huey-Kang Sytwu
- Department of Microbiology and Immunology, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Graduate Institute of Medical Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- Graduate Institute of Life Sciences, National Defense Medical Center, No. 161, Section 6, MinChuan East Road, Neihu, Taipei City 114, Taiwan.
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, No. 35, Keyan Road, Zhunan, Miaoli County 350, Taiwan.
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Rodríguez-Carrio J, Alperi-López M, Naves-Díaz M, Dusso A, López P, Ballina-García FJ, Cannata-Andía JB, Suárez A. Vitamin D Receptor Polymorphism and DHCR7 Contribute to the Abnormal Interplay Between Vitamin D and Lipid Profile in Rheumatoid Arthritis. Sci Rep 2019; 9:2546. [PMID: 30796319 PMCID: PMC6385268 DOI: 10.1038/s41598-019-38756-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/09/2019] [Indexed: 01/08/2023] Open
Abstract
Emerging evidence suggests a role for 7-dehydrocholesterol reductase (DHCR7) in the crosstalk between cholesterol and vitamin D. Our aim was to evaluate the impact of vitamin D-related polymorphisms and DHCR7 levels in the association between vitamin D deficiency and altered lipid profile in rheumatoid arthritis (RA). Serum 25(OH)-vitamin D, DHCR7 levels and vitamin D-related polymorphisms (VDR-rs2228570, CYP27A1-rs933994, CYP2R1-rs10741657 and DHCR7-rs12785878) were analyzed in 211 RA patients,94 controls and in a prospective cohort of 13 RA patients undergoing TNFα-blockade. Vitamin D was decreased in RA (p < 0.001), correlated to HDL-cholesterol (r = 0.217, p < 0.001) and total-/HDL-cholesterol ratio (r = -0.227, p = 0.004). These correlations were restricted to the VDR-rs2228570 status. Vitamin D deficiency was associated with lower HDL-cholesterol (p = 0.028), higher tender (p = 0.005) and swollen (p = 0.002) joint counts, higher DAS28 (p = 0.018) and HAQ (p = 0.024) in AG/AA-patients but not in their GG-counterparts. The associations among DHCR7, vitamin D and lipid profile followed a seasonal pattern, decreased DHCR7 (p = 0.008) and vitamin D (p < 0.001) and increased total-cholesterol (p = 0.025) being found in winter/spring. Increasing vitamin D upon TNFα-blockade paralleled RA clinical improvement (r = -0.610, p = 0.027) and DHCR7 elevation (r = 0.766, p = 0.002). In conclusion, vitamin D-related polymorphisms and DHCR7 are pivotal to understand the complex, seasonal associations between vitamin D and lipid profile in RA.
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Affiliation(s)
- Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Mercedes Alperi-López
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Manuel Naves-Díaz
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Adriana Dusso
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Patricia López
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Francisco Javier Ballina-García
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.,Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Jorge B Cannata-Andía
- Bone and Mineral Research Unit, REDinREN del ISCIII, Hospital Universitario Central de Asturias, Oviedo, Spain. .,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.
| | - Ana Suárez
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Spain.,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
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18
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Crotti C, Becciolini A, Biggioggero M, Favalli EG. Vitamin D and Spondyloarthritis: Review of the Literature. Open Rheumatol J 2018. [DOI: 10.2174/1874312901812010214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background:
Spondyloarthritides (SpAs) encompass heterogeneous diseases sharing similar genetic background, pathogenic mechanisms, and phenotypic features. Vitamin D is essential for calcium metabolism and skeletal homeostasis. Some recent evidences reported supplemental functions of vitamin D, such as modulation of inflammatory reactions.
Objective:
To analyze published data about a possible association between vitamin D and SpAs.
Results:
Vitamin D could play a role in immune reactions, influencing both immune and adaptive response. Vitamin D deficiency is more frequent in SpAs than in general population: an active and more severe disease infers patients’ mobility and reduces sunlight exposure. Quiescent inflammatory bowel disease, frequently associated with SpAs, could worsen vitamin D deficiency. All the parameters related to UVB exposure are the most important determinants for vitamin D status and need to be considered evaluating the vitamin D levels in SpAs.
Apart from musculoskeletal problems, patients affected by SpAs frequently suffer from other comorbidities, especially cardiovascular diseases and osteoporosis, and vitamin D status could have a relevance in this field. Bone is involved in SpAs with a dualistic role, coexisting trabecular bone resorption and new bone formation.
It seems rational to monitor vitamin D levels in SpA subjects and to target it to global health threshold.
Conclusion:
Literature data were not completely in agreement about a possible relation between poor vitamin D status and onset or worse disease course of SpAs. In fact, these results come from cross-sectional studies, which affect our ability to infer causality. Therefore, large, randomized controlled trials are needed.
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19
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Mok CC, Bro ET, Ho LY, Singh RJ, Jannetto PJ. Serum 25-hydroxyvitamin D3 levels and flares of systemic lupus erythematosus: a longitudinal cohort analysis. Clin Rheumatol 2018; 37:2685-2692. [PMID: 30014357 DOI: 10.1007/s10067-018-4204-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/29/2018] [Accepted: 07/09/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study is to evaluate the relationship between baseline serum 25-hydroxyvitamin D3 levels and SLE activity/flares over time. This is a longitudinal study of 276 patients who fulfilled ≥ 4 ACR criteria for SLE and recruited in the year 2011. Serum samples were collected at baseline and assayed for 25-hydroxyvitamin D3 at the end of a mean follow-up of 32.5 months. Participants were stratified into three groups according to baseline 25-hydroxyvitamin D3 levels: group I (< 15 ng/ml, deficiency), group II (15-30 ng/ml, insufficiency), and group III (> 30 ng/ml, adequate). Baseline and summated SLE disease activity index (SLEDAI) score over time and the annual incidence of lupus flares were compared among these groups. 25-hydroxyvitamin D3 levels of < 15, 15-30, and > 30 ng/ml were present in 26, 54, and 20% of the recruited patients, respectively. Group I had significantly higher baseline SLEDAI scores. After a follow-up of 32.5 ± 5.5 months, 153 mild/moderate and 91 severe flares developed. The mean summated SLEDAI was 3.2 ± 2.0 in group I, 2.4 ± 1.9 in group II and 2.7 ± 2.1 in group III patients (P = 0.02). The annual incidence of mild/moderate and severe flares was 0.26 ± 0.39 and 0.20 ± 0.45 (group I); 0.20 ± 0.33 and 0.09 ± 0.22 (group II); and 0.20 ± 0.32 and 0.14 ± 0.46 (group III), respectively (P > 0.05). In a subgroup of 73 patients who were clinically and serologically quiescent at baseline, a similar trend of more flares was observed in group I patients. Vitamin D deficiency was frequent in Chinese SLE patients and was associated with more active disease at baseline and over time, as well as a trend of more severe lupus flares.
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Affiliation(s)
- Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China.
| | - Eric T Bro
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Ling Yin Ho
- Department of Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China
| | - Ravinder J Singh
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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20
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Vitamin D3 inhibits the proliferation of T helper cells, downregulate CD4+ T cell cytokines and upregulate inhibitory markers. Hum Immunol 2018. [DOI: 10.1016/j.humimm.2018.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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21
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Bae SC, Lee YH. Vitamin D level and risk of systemic lupus erythematosus and rheumatoid arthritis: a Mendelian randomization. Clin Rheumatol 2018; 37:2415-2421. [PMID: 29799605 DOI: 10.1007/s10067-018-4152-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/09/2018] [Accepted: 05/15/2018] [Indexed: 12/31/2022]
Abstract
The aim of this study was to examine whether the vitamin D level is causally associated with risk of systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA). We performed two-sample Mendelian randomization (MR) analyses using the inverse-variance weighted (IVW), weighted median, and MR-Egger regression methods on publicly available summary statistics datasets using two vitamin D level genome-wide association studies (GWASs) as exposure and SLE and RA GWASs on people of European descent as outcomes. We selected three independent single-nucleotide polymorphisms located at SSTR4 (rs2207173), GC (rs2282679), and NADSYN1 (3829251) with genome-wide significance from two GWASs on vitamin D levels as instrumental variables. The IVW, weighted median, and MR-Egger regression methods yielded no evidence of a causal association between vitamin D level and risk of SLE (beta = 0.032, SE = 0.119, p = 0.789; beta = 0.233, SE = 0.274, p = 0.552; beta = 0.054, SE = 0.125, p = 0.665; respectively) or RA (beta = 0.026, SE = 0.061, p = 0.664; beta = 0.025, SE = 0.065, p = 0.695; beta = 0.025, SE = 0.065, p = 0.695; respectively). In addition, MR-Egger regression revealed directional pleiotropy was unlikely to be biasing the result for SLE (intercept = - 0.058, p = 0.545) or RA (intercept = - 0.027, p = 0.558). The MR estimates from IVW, weighted median, and MR-Egger regression analyses were consistent. MR analysis did not support a causal association between the vitamin D level and SLE or RA.
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Affiliation(s)
- Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
| | - Young Ho Lee
- Department of Rheumatology, Korea University College of Medicine, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, South Korea.
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Han J, Zhang X, Saraf SL, Gowhari M, Molokie RE, Hassan J, Jain S, Shah BN, Abbasi T, Machado RF, Gordeuk VR. Risk factors for vitamin D deficiency in sickle cell disease. Br J Haematol 2018; 181:828-835. [PMID: 29767851 DOI: 10.1111/bjh.15270] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/23/2018] [Indexed: 12/22/2022]
Abstract
Vitamin D deficiency (VDD), 25-OHD levels <20 ng/ml, is prevalent among patients with sickle cell disease (SCD) and is linked to acute and chronic pain and bone fracture in this population. There is limited literature regarding VDD-associated risk factors for SCD. We examined potential clinical and genomic parameters associated with VDD in 335 adults with SCD in a cross-sectional study. VDD was present in 65% of adult SCD patients, and 25-OHD levels independently and positively correlated with older age (P < 0·001) and vitamin D supplementation (P < 0·001). 25-OHD levels were higher in SCD patients over 40 years of age compared to the general African-American population. Both lower 25-OHD levels and increased pain frequency were associated with increased expression of SLC6A5 encoding glycine transporter-2 (GlyT2), a protein involved in neuronal pain pathways. Lower 25-OHD levels were also associated with increased expression of CYP3A4, and with decreased expression of GC (also termed DBP) and VDR, three genes involved in vitamin D metabolism. We conclude that vitamin D supplementation should be an almost universal feature of the care of young adults with SCD, and that further research is warranted into genomic factors that regulate vitamin D metabolism in SCD.
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Affiliation(s)
- Jin Han
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA.,Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA.,Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Xu Zhang
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Santosh L Saraf
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Michel Gowhari
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Robert E Molokie
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA.,Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Johara Hassan
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Shivi Jain
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Binal N Shah
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Taimur Abbasi
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
| | - Roberto F Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University Department of Medicine, Indianapolis, IN, USA
| | - Victor R Gordeuk
- Department of Medicine, Hematology/Oncology, University of Illinois at Chicago, Chicago, IL, USA
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Zheng C, He L, Liu L, Zhu J, Jin T. The efficacy of vitamin D in multiple sclerosis: A meta-analysis. Mult Scler Relat Disord 2018; 23:56-61. [PMID: 29778041 DOI: 10.1016/j.msard.2018.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 05/11/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic inflammatory demyelination disorder in the central nervous system (CNS) leading to a high level of neurological disability. The pathogenesis of MS remains largely unknown, which explains the lack of significant efficacy of therapy in MS. Vitamin D deficiency is widely considered to be an environmental risk factor for MS. Many studies investigating the therapeutic effects of vitamin D on MS have been applied. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of vitamin D in MS patients. METHODS To obtain a more comprehensive estimate of the efficacy of vitamin D on MS patients, we conducted a meta-analysis to determine the role of vitamin D in MS. The PubMed, EMBASE and Cochrane databases were searched in October 2017. Randomized, double-blind, placebo-controlled clinical trials recorded within the three main databases were considered. The analysis was conducted for two specific outcomes: Expanded Disability Status Scale (EDSS) score and annual relapse rate (ARR). RESULTS Vitamin D3 as add-on treatment had no significant therapeutic effect on MS according to EDSS score (mean difference -0.01 [95% CI -0.34 to 0.33]). The ARR was higher in the vitamin D group than in the placebo group (mean difference 0.05 [95% CI 0.01 to 0.1]). CONCLUSION Our findings suggest that vitamin D appeared to have no therapeutic effect on EDSS score or ARR in the patients with MS.
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Affiliation(s)
- Chao Zheng
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
| | - Liang He
- Department of Urinary Surgery, The First Hospital of Jilin University, Changchun, China
| | - Lingling Liu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China
| | - Jie Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Tao Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71, Changchun 130021, China.
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Abstract
PURPOSE OF REVIEW In recent years, there has been a growing interest in the value of vitamin D and its effects on autoimmunity. The aim of this review is to summarize the current knowledge on the association between vitamin D and rheumatoid arthritis (RA) in terms of prevalence, disease activity, clinical expression, serology and gene polymorphisms of vitamin D receptors. RECENT FINDINGS Studies have shown contrasting findings concerning the association between vitamin D levels and RA. Vitamin D seems to have immunomodulatory properties. Therefore, low vitamin D levels could contribute to increased immune activation. However, the potential role of vitamin D supplementation in preventing RA manifestation and its beneficial role as a component of RA treatment remain controversial. The relationship between RA susceptibility and vitamin D polymorphisms is also unclear. SUMMARY Despite advancements synthesized by some recent meta-analyses, the relationship between vitamin D and RA requires further evaluation. Further research is needed to confirm the relationship between RA susceptibility and vitamin D polymorphisms and to determine whether vitamin D plays a role in preventing the manifestation of RA. Finally, additional studies are required to determine the impact and optimal amount of vitamin D supplementation in the treatment of RA patients.
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Stagi S, Rigante D. Vitamin D and juvenile systemic lupus erythematosus: Lights, shadows and still unresolved issues. Autoimmun Rev 2018; 17:290-300. [PMID: 29353100 DOI: 10.1016/j.autrev.2018.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 02/07/2023]
Abstract
Systemic lupus erythematosus (SLE) and juvenile SLE (jSLE) are autoimmune disorders naturally associated with several genetic, environmental, hormonal, and immunological contributing factors. It has been assumed that vitamin D deficiency may have a role in the immune activation of patients with SLE and play an active part in many comorbidities and even complications. A host of clinical studies suggested that vitamin D exerts inhibitory effects on many immunological abnormalities associated with SLE, also in children and adolescents, while different reports have hypothesized that vitamin D may be associated with accelerated cardiovascular disease in SLE. This review updates and summarizes the information related to the immunoregulatory effects of vitamin D and its importance in jSLE, discusses the innumerable correlations between vitamin D and disease activity, including clinical expression and gene polymorphisms of vitamin D receptor as well as the recommendations for vitamin D supplementation in these patients. Despite the excitement raised by many data obtained about vitamin D and its influence on several aspects of the disease, further well-designed perspective trials are required to define the exact role that vitamin D may have in the management of both SLE and jSLE.
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Affiliation(s)
- Stefano Stagi
- Health Science Department, University of Florence, Anna Meyer Children's University Hospital, Florence, Italy.
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica Sacro Cuore, Rome, Italy
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Vitamin D and systemic lupus erythematosus - The hype and the hope. Autoimmun Rev 2017; 17:19-23. [PMID: 29108830 DOI: 10.1016/j.autrev.2017.11.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 09/07/2017] [Indexed: 02/07/2023]
Abstract
Over the past 20years, much has been written about the potential role of vitamin D in on adverse health outcomes. In recent years, evidence has accumulated regarding the effect of vitamin D on the immune system, and its different cells. Some studies have noted lower vitamin D concentrations in patients with SLE. These epidemiological data still not answer the question: is vitamin D deficiency the cause or the effect? To answer this, we will discuss the association between vitamin D deficiency and SLE and review the evidence from interventional studies.
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Vitamin D Status, Disease Activity, and Endothelial Dysfunction in Early Rheumatoid Arthritis Patients. DISEASE MARKERS 2017; 2017:5241012. [PMID: 29200598 PMCID: PMC5671710 DOI: 10.1155/2017/5241012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 09/16/2017] [Accepted: 09/28/2017] [Indexed: 02/06/2023]
Abstract
Cardiovascular diseases represent important complications in rheumatoid arthritis (RA) patients, generated by an accelerated atherosclerosis. The aim of this study is represented by the assessment of the correlations between serum levels of vitamin D, disease activity, and endothelial dysfunction in patients with early RA. Material and Methods. The study was performed on a group of 35 patients with early RA and 35 healthy subjects matched for age and gender, as controls. In all studied subjects, the following were determined: inflammatory markers, insulin resistance, vitamin D levels, and endothelial dysfunction. Statistical analysis were performed using the Student's t-test and the Pearson's test. p values of less than 0.05 were considered statistically significant. Results. The group of patients with RA patients presented inflammation, low levels of vitamin D, elevated insulin resistance, and reduced flow-mediated vasodilation, statistically significant compared to the control group (p < 0.00001). Significant inverse correlations between the levels of 25(OH) vitamin D and DAS28, respective insulin resistance, and significant positive correlation between 25(OH) vitamin D and endothelial function were demonstrated. Conclusion. In early RA patients with moderate and high disease activity, low serum levels of vitamin D were associated with disease activity, increased insulin resistance, and endothelial dysfunction.
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Helde-Frankling M, Björkhem-Bergman L. Vitamin D in Pain Management. Int J Mol Sci 2017; 18:E2170. [PMID: 29057787 PMCID: PMC5666851 DOI: 10.3390/ijms18102170] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 09/29/2017] [Accepted: 10/11/2017] [Indexed: 12/12/2022] Open
Abstract
Vitamin D is a hormone synthesized in the skin in the presence of sunlight. Like other hormones, vitamin D plays a role in a wide range of processes in the body. Here we review the possible role of vitamin D in nociceptive and inflammatory pain. In observational studies, low vitamin D levels have been associated with increased pain and higher opioid doses. Recent interventional studies have shown promising effects of vitamin D supplementation on cancer pain and muscular pain-but only in patients with insufficient levels of vitamin D when starting intervention. Possible mechanisms for vitamin D in pain management are the anti-inflammatory effects mediated by reduced cytokine and prostaglandin release and effects on T-cell responses. The recent finding of vitamin D-mediated inhibition of Prostaglandin E2 (PGE2) is especially interesting and exhibits a credible mechanistic explanation. Having reviewed current literature, we suggest that patients with deficient levels defined as 25-hydroxyvitamin D (25-OHD) levels <30 nmol/L are most likely to benefit from supplementation, while individuals with 25-OHD >50 nmol/L probably have little benefit from supplementation. Our conclusion is that vitamin D may constitute a safe, simple and potentially beneficial way to reduce pain among patients with vitamin D deficiency, but that more randomized and placebo-controlled studies are needed before any firm conclusions can be drawn.
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Affiliation(s)
- Maria Helde-Frankling
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen 12, SE-125 59 Älvsjö, Sweden.
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
| | - Linda Björkhem-Bergman
- ASIH Stockholm Södra, Långbro Park, Palliative Home Care and Hospice Ward, Bergtallsvägen 12, SE-125 59 Älvsjö, Sweden.
- Department of Laboratory Medicine, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
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Huhtakangas JA, Veijola J, Turunen S, Karjalainen A, Valkealahti M, Nousiainen T, Yli-Luukko S, Vuolteenaho O, Lehenkari P. 1,25(OH) 2D 3 and calcipotriol, its hypocalcemic analog, exert a long-lasting anti-inflammatory and anti-proliferative effect in synoviocytes cultured from patients with rheumatoid arthritis and osteoarthritis. J Steroid Biochem Mol Biol 2017; 173:13-22. [PMID: 28167299 DOI: 10.1016/j.jsbmb.2017.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 01/08/2017] [Accepted: 01/24/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We investigated the effects of 1,25-dihydroxy vitamin D3 (1,25(OH)2D3), i.e. biologically active vitamin D and calcipotriol, a vitamin D analog, on growth and secretion of inflammatory mediators in synovial stromal cells (SSC) of patients with rheumatoid arthritis (RA) or osteoarthritis (OA). METHODS Synovial stromal cells (SSC) isolated during knee prosthesis surgery from four patients with RA and four with OA were exposed to 1,25(OH)2D3 or calcipotriol with or without stimulation of cells with IL-1β or TNF-α. The proliferation of cells was studied by MTT assay. Levels of cytokines were analyzed by a magnetic bead-based multiplex assay (a panel of 27 important cytokines and IL-6 alone) and RT-PCR was used to validate the concentrations of the key cytokines secreted by SSC. The vitamin D receptor (VDR) was visualized by immunofluorescence in SSC and by immunohistochemistry in the synovial tissues of three RA and three OA patients. RESULTS We detected intense staining for VDR in the synovial lining and vascular endothelium in tissue sections from all our RA and OA patients. Both 1,25(OH)2D3 and calcipotriol inhibited SSC proliferation for a prolonged time (up to 23 days with calcipotriol), but dexamethasone tended to increase SSC proliferation in a 4-day culture. 1,25(OH)2D3, calcipotriol and dexamethasone reduced the secretion of most inflammatory factors. Calcipotriol and dexamethasone additively reduced the secretions of IL-6, IFN-γ, basic FGF and VEGF in TNF-α stimulated SSC. The level of IL-6 was still diminished at 10 days after exposure, emphasizing the long-term impact of calcipotriol on SSC. CONCLUSIONS Exposure for 24-48h to 1,25(OH)2D3 or calcipotriol causes a long-lasting inhibition of cell proliferation and cytokine production in SSC in vitro.
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Affiliation(s)
- Johanna A Huhtakangas
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Rheumatology Unit, Department of Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Johanna Veijola
- Biochemistry and Molecular Medicine Research Unit, Medical Research Center Oulu, Oulu University, Oulu, Finland.
| | - Sanna Turunen
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Anna Karjalainen
- Rheumatology Unit, Department of Medicine, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Maarit Valkealahti
- Division of Operative Care, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Tomi Nousiainen
- Division of Operative Care, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Susanna Yli-Luukko
- Division of Operative Care, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Olli Vuolteenaho
- Biomedicine Unit, Department of Physiology, Medical Research Center Oulu, Oulu University, Oulu, Finland.
| | - Petri Lehenkari
- Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Division of Operative Care, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Maldonado G, Paredes C, Guerrero R, Ríos C. Determination of Vitamin D Status in a Population of Ecuadorian Subjects. ScientificWorldJournal 2017; 2017:3831275. [PMID: 28900630 PMCID: PMC5576417 DOI: 10.1155/2017/3831275] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/16/2017] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Vitamin D is a preprohormone known to play a key role in phosphocalcic metabolism; its main source comes from the synthesis at the skin level by ultraviolet (UV) radiation. OBJECTIVE The purpose of this study was to determine the levels of vitamin D in an Ecuadorian population. MATERIALS AND METHODS Retrospective study of Ecuadorian subjects from the city of Guayaquil, who had an initial study of 25 (OH)-D serum, as the indicator of Vitamin D status, in the period of 2015-2016. RESULTS A total of 269 Ecuadorian subjects were analyzed, with a mean age of 54.73 ± 16.58; 85% (229) were females and 15% (41) males; mean vitamin D was 27.29 ± 10.12 ng/dl [6.41-88.74]; 70% of the population showed levels below 30 ng/dL of vitamin D, whereas only 30% (81) had normal values. 69% (185) had levels between 29 and 10 ng/dl and 1% (3) levels below 10 ng/dl. High levels of vitamin D were evidenced in the summer months in relation to the winter months. CONCLUSION It is evident that, despite the location of Ecuador and the intensity of UV rays it receives throughout the year, Ecuadorian subjects have insufficient levels of vitamin D.
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Affiliation(s)
- G. Maldonado
- Universidad de Especialidades Espíritu Santo, Km. 2.5 Vía la Puntilla, Samborondón, Ecuador
| | - C. Paredes
- Universidad de Especialidades Espíritu Santo, Km. 2.5 Vía la Puntilla, Samborondón, Ecuador
| | - R. Guerrero
- Universidad de Especialidades Espíritu Santo, Km. 2.5 Vía la Puntilla, Samborondón, Ecuador
| | - C. Ríos
- Centro de Reumatología y Rehabilitación, El Oro y Ambato 1004, Guayaquil, Ecuador
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High Vitamin D Levels May Downregulate Inflammation in Patients with Behçet's Disease. Int J Inflam 2017; 2017:8608716. [PMID: 28660088 PMCID: PMC5474237 DOI: 10.1155/2017/8608716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/01/2017] [Accepted: 05/09/2017] [Indexed: 01/23/2023] Open
Abstract
Vitamin D plays a significant role in the immune system modulation and may confer a protective role in autoimmune diseases. We conducted a case-control study to compare 25(OH)D levels in patients with BD who were managed at a regional rheumatology programme in the midwest region of Ireland compared to matched controls. Healthy controls were selected from the Irish health system and matched in 1 : 5 ratio for age, sex, and the month of the year. 25(OH)D levels <20 nmol/L were classified as deficient while levels between 20 and 40 nmol/L were classified as insufficient. Differences between groups were assessed using Mann-Whitney test and associations between cases and controls were expressed as odds ratios and 95% confidence intervals. Nineteen patients with BD were compared with 95 controls matched by age, sex, and month of blood draw. 25(OH)D levels were significantly higher in patients in BD than in matched controls (median values: 45 nmol/L versus 22 nmol/L, p < 0.005) and tended to be lower in patients with active disease than in those without (median values: 35 nmol/L (IQR: 22.75-47.25 nm/L) versus 50 nmol/L (IQR: 35-67 nmol/L), p = 0.11). Compared to controls, patients with BD were significantly less likely to have 25(OH)D deficiency or insufficiency (OR: 0.09, 95% CI: 0.03-0.28, p < 0.001). Our findings suggest a possible role for 25(OH)D in modifying the inflammatory response in BD and uncover a potential opportunity to assess whether correction of Vit D deficiency confers protective benefits.
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Franco AS, Freitas TQ, Bernardo WM, Pereira RMR. Vitamin D supplementation and disease activity in patients with immune-mediated rheumatic diseases: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e7024. [PMID: 28591033 PMCID: PMC5466211 DOI: 10.1097/md.0000000000007024] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D serum levels and the presence and activity of rheumatic conditions have been associated. However, many studies are merely observational, and the existent randomized clinical trials were never systematically analyzed. Therefore, this study aims to provide a systematic review and meta-analysis of such a topic. METHODS MEDLINE, EMBASE, LILACS, COCHRANE, and CINAHL were explored to identify randomized trials that investigated clinical repercussions of vitamin D (or analogs) supplementation for at least 3 months in rheumatic diseases. Standardized clinical and/or laboratorial outcomes related to disease activity were analyzed according to each disease before and after supplementation. RESULTS Database searches rendered 668 results; 9 were included-5 on rheumatoid arthritis, 3 on systemic lupus erythematosus, and 1 on systemic sclerosis. Seven of the studies were meta-analyzed. After vitamin D supplementation, rheumatoid arthritis recurrence decreased; however, not significantly (risk difference = -0.10, 95% CI = -0.21, 0.00, P = .05). No statistical significance was observed regarding visual analog scale (mean difference = 2.79, 95% CI = -1.87, 7.44, P = .24) and disease activity score28 (mean difference = -0.31, 95% CI = -0.86, 0.25, P = .28). Regarding systemic lupus erythematosus, anti-dsDNA positivity was significantly reduced (risk difference = -0.10, 95% CI = -0.18, -0.03; P = .005). CONCLUSION Vitamin D supplementation reduced anti-dsDNA positivity on systemic lupus erythematosus and could possibly reduce rheumatoid arthritis recurrence, although novel randomized clinical trials are needed to confirm and extend the benefits of this hormone in immune-mediated rheumatic diseases.
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Affiliation(s)
- André Silva Franco
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo
| | - Thiago Quadrante Freitas
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo
| | - Wanderley M. Bernardo
- Evidence-based Guidelines Developing—Brazilian Medical Association—Sao Paulo, Sao Paulo, Brazil
| | - Rosa Maria R. Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina da Universidade de Sao Paulo
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García-Carrasco M, Romero-Galvez JL. Vitamin D and cardiovascular disease in patients with systemic lupus erythematosus. REUMATOLOGIA CLINICA 2016; 12:241-243. [PMID: 27553578 DOI: 10.1016/j.reuma.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 07/26/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Mario García-Carrasco
- Departamento de Inmunología y Reumatología, Facultad de Medicina, Benemérita Universidad Autónoma de Puebla, Puebla, México; Unidad de Investigación de Enfermedad Autoinmunes Sistémicas, Hospital General Regional #36, Instituto Mexicano del Seguro Social, Puebla, México.
| | - Jose Luis Romero-Galvez
- Servicio de Alergología e Inmunología, Hospital Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Puebla, México
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Thorsen SU, Pipper CB, Alberdi-Saugstrup M, Nielsen S, Cohen A, Lundqvist M, Thygesen LC, Ascherio A, Svensson J. No association between vitamin D levels around time of birth and later risk of developing oligo- and polyarticular juvenile idiopathic arthritis: a Danish case–cohort study. Scand J Rheumatol 2016; 46:104-111. [DOI: 10.1080/03009742.2016.1178325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- SU Thorsen
- Copenhagen Diabetes Research Centre (CPH-DIRECT), Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - CB Pipper
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M Alberdi-Saugstrup
- Paediatric Rheumatology Clinic, Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics, Næstved Hospital, Næstved, Denmark
| | - S Nielsen
- Paediatric Rheumatology Clinic, Rigshospitalet, Copenhagen, Denmark
| | - A Cohen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - M Lundqvist
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - LC Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A Ascherio
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - J Svensson
- Copenhagen Diabetes Research Centre (CPH-DIRECT), Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
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Oma I, Andersen JK, Lyberg T, Molberg Ø, Whist JE, Fagerland MW, Almdahl SM, Hollan I. Plasma vitamin D levels and inflammation in the aortic wall of patients with coronary artery disease with and without inflammatory rheumatic disease. Scand J Rheumatol 2016; 46:198-205. [PMID: 27379927 DOI: 10.3109/03009742.2016.1172664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Vitamin D modulates inflammation, and this may explain the observed associations between vitamin D status and disorders driven by systemic inflammation, such as coronary artery disease (CAD) and inflammatory rheumatic diseases (IRDs). The aims of this study were to assess vitamin D status in patients with CAD alone and in patients with CAD and IRD, and to explore potential associations between vitamin D status and the presence of mononuclear cell infiltrates (MCIs) in the aortic adventitia of these patients. METHOD Plasma levels of 25-hydroxyvitamin D3 [(25(OH)D3] were determined by radioimmunoassay and 1,25-dihydroxyvitamin D3 [1,25(OH)2D3] by enzyme immunoassay in the 121 patients from the Feiring Heart Biopsy Study (FHBS) who had available histology data on adventitial MCIs; 53 of these had CAD alone and 68 had CAD and IRD. RESULTS In the crude analysis, vitamin D levels were similar in CAD patients with and without IRD. After adjustment for potential confounders, IRD was associated with an increase of 8.8 nmol/L [95% confidence interval (CI) 1.0-16.6; p = 0.027] in 25(OH)D3 and an increase of 18.8 pmol/L (95% CI 4.3-33.3; p = 0.012) in 1,25(OH)2D3, while MCIs in the aortic adventitia were associated with lower levels of 1,25(OH)2D3 (β = -18.8, 95% CI -33.6 to -4.0; p = 0.014). CONCLUSIONS IRD was associated with higher levels of both 25(OH)D3 and 1,25(OH)2D3. These findings argue against the hypothesis that patients with high systemic inflammatory burden (CAD+IRD) should have lower vitamin D levels than those with less inflammation (CAD only). Of note, when controlled for potential confounders, low 1,25(OH)2D3 levels were associated with adventitial aortic inflammation.
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Affiliation(s)
- I Oma
- a Department of Pathology , Innlandet Hospital Trust , Lillehammer , Norway.,b Institute of Clinical Medicine , University of Oslo , Oslo , Norway
| | - J K Andersen
- c Department of Health, Technology and Society , Norwegian University of Science and Technology , Gjøvik , Norway
| | - T Lyberg
- d Department of Medical Biochemistry , Oslo University Hospital , Oslo , Norway
| | - Ø Molberg
- e Department of Rheumatology, Dermatology and Infectious Diseases , University of Oslo , Oslo , Norway
| | - J E Whist
- f Department of Medical Biochemistry , Innlandet Hospital Trust , Lillehammer , Norway
| | - M W Fagerland
- g Oslo Centre for Biostatistics and Epidemiology, Research Support Services , Oslo University Hospital , Oslo , Norway
| | - S M Almdahl
- h University of North Norway , Tromsø , Norway
| | - I Hollan
- i Lillehammer Hospital for Rheumatic Diseases , Lillehammer , Norway
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Klingberg E, Oleröd G, Hammarsten O, Forsblad-d'Elia H. The vitamin D status in ankylosing spondylitis in relation to intestinal inflammation, disease activity, and bone health: a cross-sectional study. Osteoporos Int 2016; 27:2027-33. [PMID: 26809190 DOI: 10.1007/s00198-016-3489-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/08/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED We assessed the vitamin D status in ankylosing spondylitis (AS) patients and healthy controls in the late winter when no vitamin D is produced by the sunlight. The vitamin D status was often poor, but not lower in AS and not associated with disease activity or signs of gut inflammation. INTRODUCTION The aims of the study were to investigate the vitamin D levels attained mainly by dietary intake in ankylosing spondylitis (AS) in comparison with healthy controls and in relation to gut inflammation, measured indirectly by fecal calprotectin, disease activity, osteoproliferation, bone mineral density (BMD), and vertebral fractures. METHODS Serum 25-hydroxy vitamin D (25(OH)D) was measured in 203 AS patients and 120 healthy controls at the end of "the vitamin D winter," when the out-door UVB irradiation is too low to allow synthesis of vitamin D3 in the skin at the latitude of Gothenburg, Sweden. Fecal calprotectin was measured in stool samples. Disease activity was assessed with CRP, ESR, ASDASCRP, BASDAI, BAS-G, BASFI, and BASMI. Lateral spine radiographs were scored for osteoproliferation and vertebral fractures using the mSASSS and Genant scores. BMD was measured in the lumbar spine and femoral neck. RESULTS Vitamin D insufficiency (a serum 25(OH)D <50 nmol/L) was found in approximately 50 % of the AS patients, but serum 25(OH)D was not different from healthy controls and not significantly correlated with fecal calprotectin, gastrointestinal symptoms, disease activity parameters, mSASSS, BMD, or vertebral fractures. CONCLUSIONS The vitamin D status was often poor in the late winter in AS but not different from the healthy controls. No evidence for a connection between subclinical gut inflammation, malabsorption, and hypovitaminosis D was found. Serum 25(OH)D was not associated with disease activity, osteoproliferation, BMD, or vertebral fractures. We suggest that the lower vitamin D levels in AS, previously found by others, may be caused by reduced out-door UVB exposure.
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Affiliation(s)
- E Klingberg
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gröna stråket 14, SE-41345, Gothenburg, Sweden.
| | - G Oleröd
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - O Hammarsten
- Department of Clinical Chemistry and Transfusion Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - H Forsblad-d'Elia
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at the University of Gothenburg, Gröna stråket 14, SE-41345, Gothenburg, Sweden
- Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå, Sweden
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Rosen Y, Daich J, Soliman I, Brathwaite E, Shoenfeld Y. Vitamin D and autoimmunity. Scand J Rheumatol 2016; 45:439-447. [DOI: 10.3109/03009742.2016.1151072] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Y Rosen
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - J Daich
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - I Soliman
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - E Brathwaite
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Y Shoenfeld
- Zabludowicz Centre for Autoimmune Diseases, Sheba Medical Centre, Tel Hashomer, Israel
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Lima GL, Paupitz J, Aikawa NE, Takayama L, Bonfa E, Pereira RMR. Vitamin D Supplementation in Adolescents and Young Adults With Juvenile Systemic Lupus Erythematosus for Improvement in Disease Activity and Fatigue Scores: A Randomized, Double-Blind, Placebo-Controlled Trial. Arthritis Care Res (Hoboken) 2016; 68:91-8. [PMID: 25988278 DOI: 10.1002/acr.22621] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/14/2015] [Accepted: 05/12/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Vitamin D has an important immunomodulatory effect, but there are no trials that directly address the boosting of serum levels of 25-hydroxyvitamin D (25[OH]D) in juvenile-onset systemic lupus erythematosus (SLE). The aim of this study was to evaluate the effect of vitamin D supplementation on disease activity and fatigue in juvenile-onset SLE. METHODS This study was a randomized, double-blind, placebo-controlled, 24-week trial. Forty juvenile-onset SLE patients were randomized (1:1) to receive oral cholecalciferol 50,000 IU/week (juvenile-onset SLE-VitD) or placebo (juvenile-onset SLE-PL). Medications remained stable throughout the study. Serum levels of 25(OH)D were measured using radioimmunoassay. Disease activity was assessed using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and the European Consensus Lupus Activity Measurement (ECLAM). Fatigue was assessed using the Kids Fatigue Severity Scale (K-FSS). RESULTS At baseline, groups were similar regarding age, body mass index, organ involvement, glucocorticoid dose, use of immunosuppressive drugs, SLEDAI, ECLAM, K-FSS, and levels of 25(OH)D. After 24 weeks, the mean level of 25(OH)D was higher in the juvenile-onset SLE-VitD group than in the juvenile-onset SLE-PL group (P < 0.001). At the end of the intervention, a significant improvement in SLEDAI (P = 0.010) and in ECLAM (P = 0.006) was observed in the juvenile-onset SLE-VitD group compared to the juvenile-onset SLE-PL group. Regarding fatigue evaluation, a reduction of fatigue related to social life score was found in the juvenile-onset SLE-VitD group compared to the juvenile-onset SLE-PL group (P = 0.008). Cholecalciferol was well tolerated with no serious adverse events. CONCLUSION This study suggests that cholecalciferol supplementation for 24 weeks is effective in decreasing disease activity and improving fatigue in juvenile-onset SLE patients.
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Affiliation(s)
- Glauce L Lima
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Juliane Paupitz
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Nadia E Aikawa
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Liliam Takayama
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eloisa Bonfa
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Rosa M R Pereira
- Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Nakashima A, Yokoyama K, Yokoo T, Urashima M. Role of vitamin D in diabetes mellitus and chronic kidney disease. World J Diabetes 2016; 7:89-100. [PMID: 26981182 PMCID: PMC4781904 DOI: 10.4239/wjd.v7.i5.89] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 12/24/2015] [Accepted: 01/19/2016] [Indexed: 02/05/2023] Open
Abstract
Approximately 30%-50% of people are recognized to have low levels of vitamin D, and insufficiency and deficiency of vitamin D are recognized as global health problems worldwide. Although the presence of hypovitamin D increases the risk of rickets and fractures, low vitamin D levels are also associated with hypertension, cancer, and cardiovascular disease. In addition, diabetes mellitus (DM) and chronic kidney disease (CKD) are also related to vitamin D levels. Vitamin D deficiency has been linked to onset and progression of DM. Although in patients with DM the relationship between vitamin D and insulin secretion, insulin resistance, and β-cell dysfunction are pointed out, evidence regarding vitamin D levels and DM is contradictory, and well controlled studies are needed. In addition, vitamin D influences the renin-angiotensin system, inflammation, and mineral bone disease, which may be associated with the cause and progression CKD. There is increasing evidence that vitamin D deficiency may be a risk factor for DM and CKD; however, it remains uncertain whether vitamin D deficiency also predisposes to death from DM and CKD. Although at this time, supplementation with vitamin D has not been shown to improve glycemic control or prevent incident DM, clinical trials with sufficient sample size, study periods, and optimal doses of vitamin D supplementation are still needed. This review focuses on the mechanism of vitamin D insufficiency and deficiency in DM or CKD, and discusses the current evidence regarding supplementation with vitamin D in patients with these diseases.
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Carli L, Tani C, Spera V, Vagelli R, Vagnani S, Mazzantini M, Di Munno O, Mosca M. Risk factors for osteoporosis and fragility fractures in patients with systemic lupus erythematosus. Lupus Sci Med 2016; 3:e000098. [PMID: 26848397 PMCID: PMC4731833 DOI: 10.1136/lupus-2015-000098] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/11/2015] [Accepted: 09/13/2015] [Indexed: 01/17/2023]
Abstract
Osteoporosis (OP) and fragility fractures (FFx) are a known comorbidity in patients with systemic lupus erythematosus (SLE). This work aimed at evaluating (1) the prevalence of OP and FFx in a cohort of SLE and (2) the risk factors associated with both OP and FFx. The following data were collected from clinical charts: age, sex, menopausal status (MP), body mass index, smoking habits, disease duration, daily dose and cumulative glucocorticoids (GCs), type of organ involvement, comorbidities and medications. Data on bone metabolism, calcium and vitamin D supplementation and treatment with bisphosphonates, teriparatide or denosumab were collected, together with bone mineral density (BMD) values (measured by dual-energy X-ray absorptiometry (DXA)) and history of FFx (occurred after the onset of SLE and unrelated to trauma). OP and reduced BMD were defined according to the WHO. 186 patients were included (women 175, men 11; mean age 46.4±13 years, mean disease duration 14.9±9 years). At their last visit, 97 patients (52.2%) had a reduced BMD and 52 (27.9%) had OP. 22 patients (11.8%), all women, had at least one FFx; six patients (27.3%) were pre-menopausal. On univariate analysis, age, cumulative dose of GC, MP, therapy with antiepileptics and chronic renal failure (CRF) were correlated with OP (p<0.03); age, total amount of GC, MP, CRF, anticoagulants (AC) and antiepileptic therapy were correlated with FFx (p<0.05). The multivariate logistic model confirmed a direct association of OP and age, MP and antiepileptic therapy (p≤0.01) and of FFx and age, chronic therapy with AC and antiepileptics (p<0.03). In conclusion, low BMD is frequently observed in SLE, and FFx are observed also in premenopausal patients. Together with traditional risk factors (age, MP and GC), CRF and chronic treatments with AC or antiepileptics seem to be associated with a higher risk profile for OP and FFx occurrence.
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Affiliation(s)
- L Carli
- Department of Genetic Oncology and Clinical Medicine (GenOMeC) PhD, University of Siena, Siena, Italy; Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - V Spera
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - R Vagelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - S Vagnani
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Mazzantini
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - O Di Munno
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
| | - M Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine , University of Pisa , Pisa , Italy
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Serum Vitamin D Level and Rheumatoid Arthritis Disease Activity: Review and Meta-Analysis. PLoS One 2016; 11:e0146351. [PMID: 26751969 PMCID: PMC4709104 DOI: 10.1371/journal.pone.0146351] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/10/2015] [Indexed: 12/29/2022] Open
Abstract
Background The evidence from epidemiological studies concerning the relationship between serum vitamin D concentrations and rheumatoid arthritis (RA) is inconsistent. This meta-analysis is aimed at determining the magnitude of the correlation between this common autoimmune disease and vitamin D, an important nutrient known to dampen adaptive immune responses. Methods Through multiple search strategies, relevant literature was identified and evaluated for quality before May 16 2015. Data extracted from eligible studies was synthesized to calculate pooled correlation coefficient (r), mean difference (MD) and odds ratio (OR). The Venice criteria were applied to assess the credibility of the evidence for each statistically significant association. Results A total of 24 reports involving 3489 patients were selected for analysis. RA patients had lower vitamin D levels than healthy controls (MD:-16.52 nmol/L, 95% confidence intervals [CI]:-18.85 to -14.19 nmol/L). There existed a negative relationship between serum 25-hydroxyvitamin D (25OHD) level and disease activity index, e.g. 25OHD vs. Disease Activity Score in 28 joints (DAS28): r = -0.13, 95% CI -0.16 to -0.09; 25OHD vs. C-reactive protein: r = -0.12, 95% CI -0.23 to -0.00. Additionally, latitude-stratified subgroup analysis yielded a relatively stronger negative correlation between 25OHD and DAS28 in low-latitude areas. This inverse relationship also appeared more significant in developing countries than in developed countries. No publication bias was detected. Conclusion RA patients had lower vitamin D values than healthy controls. There was a negative association between serum vitamin D and RA disease activity. However, more strictly controlled studies are needed to validate these findings.
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Lee JH, Cheon JH, Hong SP, Kim TI, Kim WH. Seasonal Variation in Flares of Intestinal Behçet's Disease. Dig Dis Sci 2015; 60:3373-8. [PMID: 26386859 DOI: 10.1007/s10620-015-3863-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 09/03/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND There have been numerous investigations into the seasonality of several autoimmune diseases and inflammatory bowel disease in an effort to better understand the epidemiology and pathogenesis of these conditions. However, the relationship between the season and disease activity of intestinal Behçet's disease has not been investigated. AIMS This study aimed to evaluate the seasonal pattern of exacerbations of intestinal Behçet's disease. METHODS We evaluated 268 consecutive patients with intestinal Behçet's disease who were diagnosed and treated between November 1990 and March 2010 at Severance Hospital, Yonsei University, Seoul, Korea. Patient demographics, onset of symptoms, total number of relapses, and the month of each relapse were recorded. The relationship between the season and flares of intestinal Behçet's disease was analyzed. RESULTS A total of 339 relapses occurred in 142 patients (53 %). The median age at diagnosis was 39 (10-73) years; the median follow-up duration was 74 (7-372) months. The peak seasons for relapse were spring and autumn, especially the months of May and September (p value <0.001). Compared with winter, spring and autumn had higher rates of flares (HR 1.92 and 1.91, respectively, p value <0.001). CONCLUSIONS In this study, intestinal Behçet's disease demonstrated a biphasic pattern (peaks in spring and autumn) in exacerbations of disease, suggesting that seasonal or exogenous factors may be involved in the flares of intestinal Behçet's disease.
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Affiliation(s)
- Jin Ha Lee
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Jae Hee Cheon
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
| | - Sung Pil Hong
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Tae Il Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
| | - Won Ho Kim
- Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea
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Urruticoechea-Arana A, Martín-Martínez MA, Castañeda S, Piedra CAS, González-Juanatey C, Llorca J, Díaz-Gonzalez F, González-Gay MA. Vitamin D deficiency in chronic inflammatory rheumatic diseases: results of the cardiovascular in rheumatology [CARMA] study. Arthritis Res Ther 2015; 17:211. [PMID: 26271333 PMCID: PMC4535672 DOI: 10.1186/s13075-015-0704-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 07/02/2015] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION The aim was to study the association between 25-hydroxyvitamin D (25(OH)D) levels and the clinical characteristics of patients with chronic inflammatory rheumatic diseases (CIRD). METHODS We studied a cross-section from the baseline visit of the CARMA project (CARdiovascular in rheuMAtology), a 10-year prospective study evaluating the risk of cardiovascular events in rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) patients, and non-CIRD patients who attended rheumatology outpatient clinics from 67 hospitals in Spain. Non-CIRD group was frequency matched by age with the joint distribution of the three CIRD groups included in the study. 25(OH)D deficiency was defined if 25(OH)D vitamin levels were < 20 ng/ml. RESULTS 2.234 patients (775 RA, 738 AS and 721 PsA) and 677 non-CIRD subjects were assessed. The median (p25-p75) 25(OH)D levels were: 20.4 (14.4-29.2) ng/ml in RA, 20.9 (13.1-29.0) in AS, 20.0 (14.0-28.8) in PsA, and 24.8 (18.4-32.6) ng/ml in non-CIRD patients. We detected 25(OH)D deficiency in 40.5 % RA, 39.7 % AS, 40.9 % PsA and 26.7 % non-CIRD controls (p < 0.001). A statistically significant positive association between RA and 25(OH)D deficiency was found (adjusted (adj.) OR = 1.46; 95 % CI = 1.09-1.96); p = 0.012. This positive association did not reach statistical significance for AS (adj. OR 1.23; 95 % CI = 0.85-1.80) and PsA (adj. OR 1.32; 95 % CI = 0.94-1.84). When the parameters of disease activity, severity or functional impairment were assessed, a marginally significant association between 25(OH)D deficiency and ACPA positivity in RA patients (adj. OR = 1.45; 95 % CI = 0.99-2.12; p = 0.056), and between 25(OH)D deficiency and BASFI in AS patients (adj. OR = 1.08; 95 % CI = 0.99-1.17); p = 0.07) was also found. CONCLUSIONS Patients with RA show an increased risk of having 25(OH)D deficiency compared to non-CIRD controls.
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Affiliation(s)
| | - María A Martín-Martínez
- Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain.
| | - Santos Castañeda
- Division of Rheumatology, Hospital U de la Princesa, IIS-IPrincesa, Calle Diego de León 62, 28006, Madrid, Spain.
| | - Carlos A Sanchez Piedra
- Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain.
| | | | - Javier Llorca
- Division of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, CIBER Epidemiología y Salud Pública (CIBERESP), Santander, Spain.
| | - Federico Díaz-Gonzalez
- Research Unit of Spanish Society of Rheumatology, Calle Marqués del Duero, 5 1°A, 28001, Madrid, Spain. .,Research Unit of Spanish Society of Rheumatology, Madrid, Spain. .,School of Medicine, Universidad de La Laguna, Tenerife, Spain.
| | - Miguel A González-Gay
- Division of Rheumatology, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain. .,Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida de Valdecilla, s/n, 39008, Santander, Spain.
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Jeffery LE, Qureshi OS, Gardner D, Hou TZ, Briggs Z, Soskic B, Baker J, Raza K, Sansom DM. Vitamin D Antagonises the Suppressive Effect of Inflammatory Cytokines on CTLA-4 Expression and Regulatory Function. PLoS One 2015; 10:e0131539. [PMID: 26134669 PMCID: PMC4489761 DOI: 10.1371/journal.pone.0131539] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 06/03/2015] [Indexed: 12/12/2022] Open
Abstract
The immune suppressive protein CTLA-4 is constitutively expressed by Tregs and induced in effector T cells upon activation. Its crucial role in adaptive immunity is apparent from the fatal autoimmune pathology seen in CTLA-4 knockout mice. However, little is known regarding factors that regulate CTLA-4 expression and their effect upon its function to remove CD80 and CD86 from antigen presenting cells by transendocytosis. Th17 cells are emerging as significant players in autoimmunity as well as other diseases. Therefore, in this study we have examined the effects of Th17 polarising conditions on CTLA-4 expression and function in human T cells and show that Th17 conditions can suppress the expression of CTLA-4 and its transendocytic function. In contrast to Th17 cells, vitamin D is inversely associated with autoimmune disease. We have previously shown a striking ability of 1,25 dihydroxyvitamin D3 (1,25(OH)2D3) to enhance CTLA-4, however, its effects upon B7 transendocytosis and its activity in the context of inflammation remained unknown. Here we show that induction of CTLA-4 by 1,25(OH)2D3 can actually be enhanced in the presence of Th17 polarising cytokines. Furthermore, its transendocytic function was maintained such that T cells generated in the presence of Th17 conditions and 1,25(OH)2D3 were highly effective at capturing CTLA-4 ligands from antigen presenting cells and suppressing T cell division. Taken together, these data reveal an inhibitory effect of Th17 polarising conditions upon CTLA-4-mediated regulation and show that 1,25(OH)2D3 counteracts this effect. Given the importance of CTLA-4-mediated suppression in the control of autoimmune diseases, our novel data highlight the importance of vitamin D in inflammatory settings.
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Affiliation(s)
- Louisa E. Jeffery
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
| | - Omar S. Qureshi
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
| | - David Gardner
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
| | - Tie Z. Hou
- UCL Institute of Immunity and Transplantation, Royal Free Campus, University College London, London, United Kingdom
| | - Zoe Briggs
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
| | - Blagoje Soskic
- UCL Institute of Immunity and Transplantation, Royal Free Campus, University College London, London, United Kingdom
| | - Jennifer Baker
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
| | - Karim Raza
- Medical Research Council Centre for Immune Regulation, School of Immunity and Infection, Institute of Biomedical Research, University of Birmingham Medical School, Birmingham, United Kingdom
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, United Kingdom
- * E-mail:
| | - David M. Sansom
- UCL Institute of Immunity and Transplantation, Royal Free Campus, University College London, London, United Kingdom
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Watts RA, Mahr A, Mohammad AJ, Gatenby P, Basu N, Flores-Suárez LF. Classification, epidemiology and clinical subgrouping of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Nephrol Dial Transplant 2015; 30 Suppl 1:i14-22. [PMID: 25805746 DOI: 10.1093/ndt/gfv022] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
It is now 25 years since the first European studies on vasculitis--the anti-neutrophil cytoplasmic antibody (ANCA) standardization project. Over that period of time, there have been major developments in the classification of the vasculitides, which has permitted the conduct of high-quality epidemiology studies. Studying the epidemiology of rare diseases such as the ANCA-associated vasculitides (AAV) poses considerable challenges to epidemiologists. The first is the need for a clear definition of a case with good differentiation from similar disorders. The second is case capture. The vasculitides are rare, and therefore, a large population is required to determine the incidence and prevalence, and this poses questions of feasibility. A large population increases the risk of incomplete case detection but permits a reasonable number of cases to be collected in a practicable time frame, whereas a smaller population requires a much longer time frame to collect the necessary cases, which may also not be feasible. Statistical methods of capture-recapture analysis enable estimates to be made of the number of missing cases. The third is case ascertainment. The AAV are virtually always managed in secondary care, and therefore, hospital-based case ascertainment may be appropriate. Fourthly, the rarity of the conditions makes prospective case-control studies investigating risk factors difficult to conduct because the population size required to achieve statistical confidence is in excess of that which is readily available. Thus, much of the data on risk factors are derived from retrospective studies with inherent potential bias.
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Affiliation(s)
- Richard A Watts
- Department of Rheumatology, Ipswich Hospital and Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alfred Mahr
- Department of Internal Medicine, Hospital Saint-Louis, University Paris 7, Paris, France
| | - Aladdin J Mohammad
- Department of Clinical Sciences, Rheumatology, Lund University, Lund, Sweden Vasculitis and Lupus Clinic, Addenbrooke's Hospital, Cambridge, UK
| | - Paul Gatenby
- Department of Immunology, The Canberra Hospital and Medical School Australian National University, Canberra, Australia
| | - Neil Basu
- Musculoskeletal Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Luis Felipe Flores-Suárez
- Primary Systemic Vasculitides Clinic, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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Alahgholi-Hajibehzad M, Kasapoglu P, Jafari R, Rezaei N. The role of T regulatory cells in immunopathogenesis of myasthenia gravis: implications for therapeutics. Expert Rev Clin Immunol 2015; 11:859-70. [DOI: 10.1586/1744666x.2015.1047345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lucas RM, Norval M, Neale RE, Young AR, de Gruijl FR, Takizawa Y, van der Leun JC. The consequences for human health of stratospheric ozone depletion in association with other environmental factors. Photochem Photobiol Sci 2015; 14:53-87. [DOI: 10.1039/c4pp90033b] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ozone depletion, climate and human health.
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Affiliation(s)
- R. M. Lucas
- National Centre for Epidemiology and Population Health
- The Australian National University
- Canberra 2601
- Australia
- Telethon Kids Institute
| | - M. Norval
- Biomedical Sciences
- University of Edinburgh Medical School
- Edinburgh EH8 9AG
- UK
| | - R. E. Neale
- QIMR Berghofer Medical Research Institute
- Brisbane 4029
- Australia
| | - A. R. Young
- King's College London (KCL)
- St John's Institute of Dermatology
- London SE1 9RT
- UK
| | - F. R. de Gruijl
- Department of Dermatology
- Leiden University Medical Centre
- NL-2300 RC Leiden
- The Netherlands
| | - Y. Takizawa
- Akita University Graduate School of Medicine
- Akita Prefecture
- Japan
- National Institute for Minamata Diseases
- Kumamoto Prefecture
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Lo mejor del año en lupus eritematoso sistémico. ACTA ACUST UNITED AC 2015; 11:27-32. [DOI: 10.1016/j.reuma.2014.09.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/11/2014] [Accepted: 09/12/2014] [Indexed: 12/16/2022]
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