Vitamin D deficiency in undifferentiated connective tissue disease

Eva Zold,Edit Bodolay,Gyula Szegedi,Edit Gyimesi,Janos Gaal,Laszlo Csathy,János Kappelmayer,Margit Zeher,Peter Szodoray

doi:10.1186/ar2533

Abstract

IntroductionBoth experimental and clinical data provide evidence that vitamin D is one of those important environmental factors that can increase the prevalence of certain autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease. The aim of the present study was to investigate the prevalence of vitamin D insufficiency in patients with undifferentiated connective tissue disease (UCTD).MethodsPlasma 25(OH)D3 levels in 161 UCTD patients were measured in both summer and winter periods. Autoantibody profiles (antinuclear antibody, anti-U1-ribonucleoprotein, anti-SSA, anti-SSB, anti-Jo1, anti-Scl70, anti-double-stranded DNA, anti-centromere, anti-cardiolipin, rheumatoid factor, and anti-cyclic citrullinated peptide) and clinical symptoms of the patients were assessed.ResultsPlasma levels of 25(OH)D3 in UCTD patients were significantly lower compared with controls in both summer and winter periods (UCTD summer: 33 ± 13.4 ng/mL versus control: 39.9 ± 11.7 ng/mL, P = 0.01; UCTD winter: 27.8 ± 12.48 ng/mL versus control: 37.8 ± 12.3 ng/mL, P = 0.0001). The presence of dermatological symptoms (photosensitivity, erythema, and chronic discoid rash) and pleuritis was associated with low levels of vitamin D. During the average follow-up period of 2.3 years, 35 out of 161 patients (21.7%) with UCTD further developed into well-established connective tissue disease (CTD). Patients who progressed into CTDs had lower vitamin D levels than those who remained in the UCTD stage (vitamin D levels: CTD: 14.7 ± 6.45 ng/mL versus UCTD: 33.0 ± 13.4 ng/mL, P = 0.0001).ConclusionsIn patients with UCTD, a seasonal variance in levels of 25(OH)D3 was identified and showed that these levels were significantly lower than in controls during the corresponding seasons. Our results suggest that vitamin D deficiency in UCTD patients may play a role in the subsequent progression into well-defined CTDs.

Highlights

Both experimental and clinical data provide evidence that vitamin D is one of those important environmental factors that can increase the prevalence of certain autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease
Patients who progressed into connective tissue disease (CTD) had lower vitamin D levels than those who remained in the undifferentiated connective tissue disease (UCTD) stage
Our results suggest that vitamin D deficiency in UCTD patients may play a role in the subsequent progression into well-defined CTDs

Summary

Introduction

Both experimental and clinical data provide evidence that vitamin D is one of those important environmental factors that can increase the prevalence of certain autoimmune diseases such as systemic lupus erythematosus, rheumatoid arthritis, insulin-dependent diabetes mellitus, and inflammatory bowel disease. A less traditional function of vitamin D has been demonstrated, including substantial effects on the anti-CCP: anti-cyclic citrullinated peptide; anti-CL: anti-cardiolipin; anti-dsDNA: anti-double-stranded DNA; anti-U1-RNP: anti-U1-ribonucleoprotein; BMD: bone mineral density; CTD: connective tissue disease; ELISA: enzyme-linked immunoabsorbent assay; HPLC: high-performance liquid chromatograph; IBD: inflammatory bowel disease; IDDM: insulin-dependent diabetes mellitus; IFN-γ: interferon-gamma; IL: interleukin; MCTD: mixed connective tissue disease; MS: multiple sclerosis; PTH: parathyroid hormone; RA: rheumatoid arthritis; RF: rheumatoid factor; SLE: systemic lupus erythematosus; UCTD: undifferentiated connective tissue disease. Vitamin D has been described to modulate immune responses [1,2,3,4,5,6]

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