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    Home > Active Ingredient News > Immunology News > Vitamin D is related to lupus?

    Vitamin D is related to lupus?

    • Last Update: 2021-08-08
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference, patients with lupus obediently measure the level of vitamin D.
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    .
    Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease, although its pathogenesis is not clear.
    However, it is believed that some unclear environmental factors in genetically susceptible individuals can induce SLE
    .

    In recent years, vitamin D (VD) deficiency has been considered a risk factor for the development of SLE and the persistence of disease activity
    .

    Unexpectedly, VD not only causes bone-related diseases, but also has an impact on rheumatism~What is the specific impact of VD on SLE? VD is a fat-soluble vitamin, which belongs to steroid compounds
    .

    There are three sources of VD in the human body, namely sunlight, food and drug supplements, but the main source of vitamin D3 (VD3, 80%~90%) is obtained through photosynthesis of the skin
    .

    VD plays an important role in calcium homeostasis
    .

    In addition to regulating the intestinal absorption of dietary calcium, renal calcium excretion and calcium ion flux in bones, it also helps to regulate the immune system
    .

    According to the literature, the prevalence of VD deficiency (20~30ng/ml) in SLE patients is 38%~96%, and the prevalence of VD deficiency (<20ng/ml) is 8%~30%[1]
    .

    1VD deficiency causes SLE activity Sumethkul et al.
    found that the VD level of patients with active SLE combined with lupus nephritis was significantly lower than that of patients without lupus nephritis, suggesting that lupus nephritis is an important predictor of VD deficiency in SLE patients
    .

    In antinuclear antibody-positive patients, VD3 levels are more closely related to SLE, and VD3 is negatively correlated with SLE activity and negatively correlated with anti-dsDNA
    .

    In the treatment of SLE patients, increasing the dose of 1,25 dihydroxy VD3[1,25-(OH)2D3] can inhibit SLE activity
    .

    Another literature reported on the relationship between VD levels and SLE disease activity, suggesting that the lack of VD in winter may be a risk factor for the SLE epidemic
    .

    2VD and SLE musculoskeletal symptoms clinicians mainly focus on reducing inflammation and controlling disease activity, but patients are more concerned about the quality of life and often report various symptoms, including more significant fatigue, sleep disorders, and cognitive dysfunction
    .

    ①Fatigue: Up to 90% of SLE patients have reported fatigue, and more than 50% believe that fatigue is the most severe symptom of disability
    .

    The cause of fatigue is still unclear, and may be related to the disease activity of SLE patients and the use of glucocorticoids
    .

    The role of VD in SLE-related fatigue has been extensively studied, and studies have found that VD is negatively correlated with fatigue
    .

    One study showed that fatigue is related to low VD levels [2]; another study also reached the same conclusion, which revealed the potential role of VD in fatigue, but it is not clear whether vitamin deficiency is related to the degree of fatigue in patients
    .

    ②Sleep disorders: The pathogenesis of sleep disorders in SLE patients is complex and diverse.
    Studies have shown that disease activity, pain, fatigue and psychological factors, especially depression, are the underlying mechanisms of sleep disorders [3]
    .

    Although the underlying link mechanism between VD deficiency and sleep disorders is not yet clear, there is evidence that VD deficiency may be associated with non-specific bone pain that disrupts sleep
    .

    Supplementing VD can improve the pain and sleep of patients with chronic pain
    .

    In addition, VD is also involved in immune regulation, so its lack can lead to changes in immune regulation and increased production of inflammatory cytokines, thereby affecting sleep
    .

    Changes in immune function may lead to tonsillar hypertrophy, airway muscle myopathy, and chronic rhinitis, all of which promote obstructive sleep apnea (a sleep disorder common in SLE patients)
    .

    ③ Cognitive dysfunction: 20% to 80% of SLE patients have cognitive dysfunction
    .

    VD has a significant effect on immune cells and nerve cells
    .

    There is a link between low VD levels and impaired brain function, because 25-hydroxyvitamin D3 crosses the blood-brain barrier to reach VD receptors present on neurons and glial cells of the central nervous system
    .

    A study explored the relationship between VD levels and cognitive dysfunction in SLE patients and concluded that the lack of 25-hydroxyvitamin D3 can independently predict cognitive dysfunction in SLE patients [4]
    .

    What is the reason why VD deficiency affects SLE? VD3 generally reflects the effect of immunosuppression.
    If the level of VD3 is reduced, the immune activity will increase, which may easily lead to autoimmune diseases
    .

    VD3 inhibits the maturation of antigen-presenting cells (APC) caused by lupus blood and inhibits the expression of major histocompatibility complex (MHC) II, CD40 and CD86, thereby reducing the immunostimulatory effect of SLE and inhibiting the production of antigen and antibody
    .

    VD3 can maintain the balance of the immune internal environment, inhibit the mutation and activation of DC in SLE patients, and inhibit the activity of IFN-α
    .

    In addition, 1,25-(OH)2D3 was used to treat SLE patients, and it was found that T-regulatory cell effects Th1 and Th17 decreased, B cells decreased, and anti-DNA antibodies decreased, while inhibiting the maturation of SLE DCs, hindering the progression of SLE disease course, proved 1,25 -(OH)2D3 can inhibit the development of SLE
    .

    How to make up VD? Supplementing VD can improve the disease activity and various laboratory indicators of SLE patients
    .

    PETRI et al.
    [5] conducted 1006 SLE patients with VD supplementation of 50,000 units per week for 128 weeks and found that the patients' lupus disease activity index and the average urine protein/creatinine ratio were improved
    .

    After supplementing enough vitamin D in children with SLE, ALSALEEM et al.
    [6] found that the children’s nephropathy symptoms such as hematuria, proteinuria, and edema, as well as joint symptoms were significantly improved, and the disease activity was lower than before, which is consistent with the results of adult SLE patients.
    [7]
    .

    Studies have found that after giving different regimens of VD, although the level of 1,25-(OH)2D3 has increased, the disease activity and serological indicators of SLE have not been significantly improved [8], which may be related to vitamin D supplementation.
    The dose and time have not yet reached a sufficient level of 1,25-(OH)2D3
    .

    Another important issue in the application of VD in the treatment of SLE is the safety of vitamin D supplementation
    .

    Under normal circumstances, the toxicity of vitamin D is very rare, the main complications are hypercalcemia and hypercalciuria
    .

    The incidence of hypercalcemia is 0.
    002%~2%
    .

    However, there are still no specific guidelines for the management of 1,25(OH)2D3 levels in SLE patients.
    In view of the complex and diverse immunological and clinical manifestations of SLE, it is recommended to formulate personalized treatment doses based on the 1,25(OH)2D3 levels of SLE patients For VD, maintain the serum 1,25-(OH)2D3 level at 40-60 ng·ml-1
    .

    Summary: At present, almost all trial patients on vitamin supplement therapy are well tolerated, so clinically for SLE patients, adequate VD intake and supplementation should be ensured
    .

    However, the appropriate serum VD level in SLE patients has not yet been determined, so large-scale, multi-center clinical trials are needed for further exploration
    .

    References [1] SchneiderL, Dos SA, SantosM, et al.
    VtiaminDand systemic lupus erythematosus: State of the art[J].
    Clin Rheumatol,2014,33(8):1033-1038.
    [2]Masoudi AN, Madani M, Sadat Z, et al.
    Fatigue and Vitamin D Status in Iranian Female Nruses[J].
    Glob J Health Sci, 2015, 8(6): 196-202.
    [3] Palagini L, Tani C, MaruriM, et al.
    Sleep disorders and systemic lupus erythmatosus[J].
    Lupus,2014,23(2):115-123.
    [4] Tay SH, Ho CS, Ho RC, et al.
    25-hydroxy vitamin D3 deficiency in dependently predicts cognitive impairment in patients with systemic lupus erythematosus[J].
    PLoS One,2015,10(12):e144149.[5]PETRI M,BELLO KJ,FANG H,et al.
    Vitamin D in SLE:modest association with disease activity and the urine protein to creatinine ratio[J].
    Arthritis Rheum,2013,65(7):1865-1871.
    [6]ALSALEEM A,ALE A,ALSAGHIER A,et al.
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