Vitamin D in Rheumatology: Cause and Effect Unclear

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September 15, 2015 • By

The controversy over vitamin D is hearty enough to confuse even seasoned rheumatologists, says Nathan Wei, MD, The Arthritis Treatment Center, Frederick, Md.

Vitamin D appears to be in the same conundrum right now in rheumatology. Although there’s the general thought that optimal levels can be beneficial for patients, it’s not always clear how much is needed, how much vitamin D contributes to disease development, and whether D has any protective factor against rheumatic disease.

What’s certain is testing -keep reading- for vitamin D levels is popular right now, says Stuart D. Kaplan, MD, chief of rheumatology atSouth Nassau Communities Hospital in Oceanside, N.Y. When he started to practice rheumatology in 1989, he says checking vitamin D levels was not even on the radar screen.

As the specialty’s knowledge of rheumatic disease has increased, there’s a general thought that vitamin D may help combat osteoporosis and reduce the risk for falls, says Linda A. Russell, MD, assistant attending physician, Hospital for Special Surgery, New York.

The current enthusiasm for Vitamin D stems, in part, from the public’s interest in finding more “natural” ways to prevent and treat disease that do not involve conventional medications, says Sharon L. Kolasinski, MD, Division of Rheumatology, University of Pennsylvania, Philadelphia.

What We Know about Vitamin D

There’s a multitude of ongoing research related to vitamin D right now, and while some questions remain unanswered, what’s clear keep reading

Vitamin D Tracks Systemic Lupus Erythematosus Activity Study first in Southern Hemisphere to examine role of vitamin D in SLE disease activity

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In systemic lupus erythematosus (SLE) low vitamin D status is associated with higher disease activity and erythrocyte sedimentation rate (ESR), while over time, an increase in serum vitamin D levels correlates with reduced SLE activity.

These findings were reported in an Australian study — the first to examine this correlation in the Southern Hemisphere — published online in Lupus Science and Medicineon April 8, 2015.

Following the discovery that vitamin D receptors are expressed by immune cells, vitamin D’s potential role in regulating the immune response has attracted attention, noted researchers led by Kristy Yap, MBBS, of the Centre for Inflammatory Diseases at Monash University, Melbourne.

Deficiency of this vitamin has been associated with several autoimmune diseases including multiple sclerosis, rheumatoid arthritis, type 1 diabetes mellitus, and SLE. A recent study, for example, showed that vitamin D3 inhibits dendritic cell maturation and expression of IFN-induced genes in SLE patients.

During 2007-2013, the Melbourne researchers studied 119 consecutive SLE patients (mean age 42.2) from the Monash Medical Centre Lupus Clinic. Of these, 77.5% were female, 56.3% were white, 37.8% were Asian, and 5.9% were of other or unknown race. With a mean disease duration of 8.7 years and a mean SLEDAI of 5.6, all patients were receiving antimalarial treatment, with 58.8% on glucocorticoids, 33.6% on immunosuppressants, and 14.2% on prednisolone. More than four in 10 (44.5%) were taking vitamin D supplements.

Baseline serum 25-hydroxyvitamin D concentration and disease activity via the SLE Disease Activity Index 2000 SLEDAI-2K) were documented, and adjustments made for the use of glucocorticoids, immunosuppressants, and vitamin D supplements.

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