Vitamin D for Lupus:
Jacob Schor ND, FABNO
August 3, 2011
A number of recent and soon to be published papers have strengthened the argument that patients with systemic lupus erythematosis (SLE) should be treated with vitamin D.
Lauren Ritterhouse et al have a paper set for publication this coming September that for presents the strongest argument to date.
Earlier studies have told us that patients with SLE have low vitamin D levels.
Mok et al’s study published June 29 in Rheumatology is perhaps the most recent paper to point to this relationship between vitamin D deficiency and SLE. In this study a total of 290 SLE patients were tested. Of these 277 (96%) had low vitamin D levels (<30 ng/ml). Of the total 290 patients, 77 (27%) had significant vitamin D deficiency (<15 ng/ml). The measurements of vitamin D were inversely correlated sith scores of disease severity. Also the lower the vitamin D level the worse the cardiovascular risk ratio calculated by dividing total cholesterol by High density lipoprotein (HDL) levels.
But in fact Mok et al may not be the first to say, ‘it’s about time.’ A June 2010 paper that compared vitamin D levels in a group of 378 SLE patients from Europe and Israel also found an inverse correlation between low vitamin D levels and disease activity.
Still there has been hesitation to suggest vitamin D treatment. Researchers prefer to wait to see results of clinical trials before making suggestions. Even though vitamin D is considered safe. Not just clinical trials but placebo controlled clinical trials. A situation that brings up Smith and Pell’s classic meta-analysis on whether parachutes prevent injuries caused by falling out of airplanes. As there are no trials in which some of the participants were assigned placebo or fake parachutes, their facetious conclusion is that we do not know whether parachutes really work or not.
Back to the paper by Lauren Ritterhouse and colleagues from the University of Oklahoma. What pushed them to suggest actually using vitamin D as a treatment?
First, in apparently healthy controls, positive ANA titers, which are evidence of early lupus, were detected in those who were vitamin D deficient. No similar increase of ANA positive titers were found in control group individual who had adequate vitamin D levels. Of the control group members who had positive ANA titers, 71% were vitamin D deficient. In those control group members who had negative ANA titers, only 22% were vitamin D deficient.
Second, vitamin D deficiency was correlated with high B cell activation and higher serum IFN alpha activity, markers of destructive inflammation.
Given that steroids are one of the common treatments for SLE and their use leads to bone loss, one would think we didn’t need any further reason to make sure these patients have adequate vitamin D levels. These new studies further strengthen the argument. But rest assured there will be objections to treating SLE patients with vitamin D, even if only to insure that they are not deficient, until there are randomized controlled trials published.
Which is all fine and good, unless you are the one falling out of the airplane.
Ritterhouse LL, Crowe SR, Niewold TB, Kamen DL, Macwana SR, Roberts VC, Dedeke AB, Harley JB, Scofield RH, Guthridge JM, James JA. Vitamin D deficiency is associated with an increased autoimmune response in healthy individuals and in patients with systemic lupus erythematosus. Ann Rheum Dis. 2011 Sep;70(9):1569-74.
Ruiz-Irastorza G, Egurbide MV, Olivares N, Martinez-Berriotxoa A, Aguirre C. Vitamin D deficiency in systemic lupus erythematosus: prevalence, predictors and clinical consequences. Rheumatology (Oxford). 2008 Jun;47(6):920-3.
Ruiz-Irastorza G, Gordo S, Olivares N, Egurbide MV, Aguirre C. Changes in vitamin D levels in patients with systemic lupus erythematosus: Effects on fatigue, disease activity, and damage. Arthritis Care Res (Hoboken). 2010 Aug;62(8):1160-5.
Kamen DL, Cooper GS, Bouali H, Shaftman SR, Hollis BW, Gilkeson GS. Vitamin D deficiency in systemic lupus erythematosus. Autoimmun Rev. 2006 Feb;5(2):114-7.
Mok CC, Birmingham DJ, Leung HW, Hebert LA, Song H, Rovin BH. Vitamin D levels in Chinese patients with systemic lupus erythematosus: relationship with disease activity, vascular risk factors and atherosclerosis. Rheumatology (Oxford). 2011 Jun 29.
Amital H, Szekanecz Z, Szücs G, Dankó K, Nagy E, Csépány T, Kiss E, Rovensky J, Tuchynova A, Kozakova D, Doria A, Corocher N, Agmon-Levin N, Barak V, Orbach H, Zandman-Goddard G, Shoenfeld Y. Serum concentrations of 25-OH vitamin D in patients with systemic lupus erythematosus (SLE) are inversely related to disease activity: is it time to routinely supplement patients with SLE with vitamin D? Ann Rheum Dis. 2010 Jun;69(6):1155-7.
Smith GC, Pell JP. Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. Int J Prosthodont. 2006 Mar-Apr;19(2):126-8.