Sufferers With SLE Could Profit from Vitamin D Supplementation, Examine Finds

Patients taking supplements showed improvements, but these were only noticeable after the patients had been taking supplements for a year.

According to new research, vitamin D supplementation appears to improve disease activity and fatigue in patients with systemic lupus erythematosus (SLE).

The study suggests that vitamin D could be a cost-effective way to improve outcomes in some patients with SLE, although the report was based on a small sample size and the authors say further studies are needed. The report was published in the journal BMC Rheumatology.

Corresponding author Rosalie Magro, MD, of the University of Malta and colleagues said that while vitamin D deficiency is common in the general population, the problem is more pronounced in people with SLE. The reasons for this are unknown, although Magro and colleagues said it might simply be that patients with SLE spend less time in sunlight compared to the general population.

Recent evidence has identified the presence of vitamin D receptors (VDR) in the innate and adaptive immune systems, opening the possibility that vitamin D deficiency may play a greater role than previously thought in diseases like SLE.

The researchers recruited a cohort of 31 patients with SLE who did not have adequate vitamin D levels. 13 of the patients were classified as vitamin D deficiency (serum 25-hydroxyvitamin D <20 ng / ml). The remaining 18 patients had a vitamin D deficiency (serum 25-hydroxyvitamin D 21-29 ng / ml). The patients in the study were 90% female and their mean age was 47.9 years.

The patients received vitamin D3 supplementation based on their baseline condition. Vitamin D deficient patients received 8,000 IU of vitamin D3 daily for 8 weeks. Those in the insufficient category received 4 weeks of therapy at the same dose. After the initial therapy, patients received a daily maintenance dose of 2000 IU.

Investigators conducted baseline, 6 month, and 12 month assessments using interviews, questionnaires, and blood tests. They also examined interferon signature genes in the ribonucleic acid of patients.

Patients in the study who received disease-modifying therapies were not allowed to increase their dose or start new therapies during the study to ensure that they did not distort the results.

After 6 months, 83.9% of the patients had achieved adequate vitamin D levels (defined as serum vitamin D ≥ 30 ng / ml. However, after 12 months the rate of vitamin D deficiency had decreased to 35.5% The researchers said this may be due to non-compliance with study protocols, based on a count of how many doses of vitamin D pills patients picked up from patients’ pharmacies. The data suggests that 64.5% of patients did not take enough tablets to reach the recommended dose.

Nonetheless, the researchers found an improvement in the overall scores on the SLE Disease Activity Index 2K scale, as well as an improvement in the fatigue severity scale after 12 months. They also found a decrease in anti-double-stranded deoxyribonucleic acid, a sign that the severity of the disease might improve. The mean gene expression scores of the interferon signature changed after 6 months but did not reach statistical significance, the authors said.

Magro and colleagues found that although vitamin D levels were much higher at 6 months, the improvements in disease activity and fatigue did not occur until after the 12 month assessment, suggesting that long-term supplementation is necessary, to achieve meaningful results.

The authors concluded that their study supports the idea of ​​screening vitamin D for patients with SLE to identify those who might benefit from supplementation.

“Correcting vitamin D deficiency in SLE patients has potential benefits in terms of suppressing the expression of genes in the interferon pathway, thus improving SLE disease activity,” they write.

Reference:

Magro R, Saliba C, Camilleri L, Scerri C, and Borg AA. Vitamin D supplementation in systemic lupus erythematosus: association with disease activity, fatigue and the gene expression of the interferon signature. BMC Rheumatol. Published online December 3, 2021. doi: 10.1186 / s41927-021-00223-1

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