Abstract
OBJECTIVES:To determine the possible association of serum 25-hydroxyvitamin D (25OHD) levels with disease activity and respiratory infection in granulomatosis with polyangiitis patients during two different periods: winter/spring and summer/autumn.METHODS:Thirty-two granulomatosis with polyangiitis patients were evaluated in the winter/spring, and the same patients (except 5) were evaluated in summer/autumn (n=27). The 25OHD levels were measured by radioimmunoassay. Disease activity was assessed by the Birmingham Vasculitis Activity Score Modified for Wegener’s Granulomatosis (BVAS/WG) and antineutrophil cytoplasmic antibody (ANCA) positivity. Respiratory infection was defined according the Centers for Disease Control and Prevention criteria.RESULTS:25OHD levels were lower among patients in winter/spring than in summer/autumn (32.31±13.10 vs. 38.98±10.97 ng/mL, p=0.04). Seven patients met the criteria for respiratory infection: 5 in winter/spring and 2 in summer/autumn. Patients with respiratory infection presented lower 25OHD levels than those without infection (25.15±11.70 vs. 36.73±12.08 ng/mL, p=0.02). A higher frequency of low vitamin D levels (25OHD<20 ng/mL) was observed in patients with respiratory infection (37.5% vs. 7.8, p=0.04). Serum 25OHD levels were comparable between patients with (BVAS/WG≥1 plus positive ANCA) and without disease activity (BVAS/WG=0 plus negative ANCA) (35.40±11.48 vs. 35.34±13.13 ng/mL, p=0.98).CONCLUSIONS:Lower 25OHD levels were associated with respiratory infection but not disease activity in granulomatosis with polyangiitis patients. Our data suggest that hypovitaminosis D could be an important risk factor for respiratory infection in granulomatosis with polyangiitis patients.
Highlights
Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) describes systemic vasculitis of small vessels that is strongly associated with antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase-3
This study evaluated serum 25OHD levels in GPA patients and demonstrated for the first time that lower serum 25OHD levels were associated with respiratory infection in these patients
Lower serum vitamin D levels were associated with a higher incidence of infections, including septic shock [26], respiratory infection [27] and influenza [27,28]
Summary
Granulomatosis with polyangiitis (GPA, previously known as Wegener’s granulomatosis) describes systemic vasculitis of small vessels that is strongly associated with antineutrophil cytoplasmic antibodies (ANCAs) directed against proteinase-3. GPA has many heterogeneous manifestations, especially in the upper and lower respiratory tracts and kidneys [1]. The respiratory tract is frequently affected in GPA, with involvement of the upper airway or the development of pulmonary disease [2]. Patients with GPA have higher mortality during the first year of disease due to infection in most cases [3]. It can be very difficult to differentiate respiratory.
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