Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
25-Hydroxyvitamin D Levels Are Inversely Correlated with Systemic Lupus Erythematosus Disease Activity Index, but Are Not Associated with Relapse-Free Survival During Six Months Follow-up of 171 Patients Included in a French Prospective Multicentric Cohor.
Schoindre1, Yoland, Jallouli2, Moez, Terrier3, Benjamin, Tanguy2, Marie-Laure, Amoura2, Zahir, Piette2, Jean-Charles, Cacoub2, Patrice
Immunomodulatory actions of vitamin D, especially on self-tolerance and B-cell homeostasis, have been well documented, and growing evidence suggests the vitamin D plays a key role in the pathogenesis and progression of autoimmune diseases. Recent studies have found an association between lower serum 25-hydroxyvitamin D [25(OH)D] levels and higher systemic lupus erythematosus (SLE) disease activity. None of them studied the role of [25(OH)D] level in predicting SLE flares. The objectives of this study were to assess the relationship between serum 25(OH)D levels and disease activity and the disease flare during a follow-up of 6 months.
This study is ancillary to the PLUS study (ClinicalTrials.gov number n°NCT00413361), a randomized prospective, double-blind, placebo-controlled multicenter trial aimed at determining whether increasing the HCQ dosage to achieve an [HCQ]>=1000 ng/mL reduces the risk of SLE flare. Serum 25(OH)D levels were measured in the M1 serum of the 171 randomised SLE patients who were followed-up 6 additional months.
The mean SLEDAI score was 2.03 ± 2.43, and 12.3% patients had active disease defined by a SLEDAI >=6. The mean 25(OH)D level was 20.6 ± 9.8 ng/mL. Thirty-one (18.2%) subjects had optimal vitamin D levels [25(OH)D >=30 ng/mL], vitamin D deficiency [25(OH)D <10] was observed in 27 (15.9%) and vitamin D insufficiency [10 <=25(OH)D <30] in 112 (65.9%) patients. In multivariate analysis, younger age (p = 0,016), higher body mass index (p = 0,007), photosensitivity (p = 0,034), absence of defined APS (p = 0,0004), and higher SLEDAI (p = 0,036) were associated with lower 25(OH)D levels. The mean SLEDAI scores were 2.6, 1.7 and 1.3 in subjects with deficiency, insufficiency, and optimal vitamin D levels, respectively. SLEDAI score was >=6 in 3 (11.1%) patients with deficiency, 10 (8.9%) patients with insufficiency, and in 2 (6.5%) patients with optimal vitamin D status. The mean 25(OH)D level was not different in patients who developed flares during the 6 months of follow-up and in patients who did not (p = 0,8). Relapse-free survival was not statistically different in patients with 25(OH)D levels <10 ng/mL compared with those with 25(OH)D levels >=10 ng/mL (p = 0,17), or in patients with 25(OH)D <30 ng/mL compared with those with 25(OH)D levels >=30 ng/mL.
Similarly to others, we found a low vitamin D status in a vast majority of patients, and an inverse correlation between 25(OH)D levels and disease activity. These results raise the question of whether achieving and maintaining an optimal vitamin D status through adequate supplementation is associated with a reduction in the risk of SLE flare. Nevertheless, there was no association between 25(OH)D levels and relapse-free survival. Further studies should prospectively assess the effect of vitamin D supplementation on disease activity and outcomes in SLE.
To cite this abstract, please use the following information:
Schoindre, Yoland, Jallouli, Moez, Terrier, Benjamin, Tanguy, Marie-Laure, Amoura, Zahir, Piette, Jean-Charles, et al; 25-Hydroxyvitamin D Levels Are Inversely Correlated with Systemic Lupus Erythematosus Disease Activity Index, but Are Not Associated with Relapse-Free Survival During Six Months Follow-up of 171 Patients Included in a French Prospective Multicentric Cohor. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1373