Bibliographic Details
| Title: |
STATUSUL VITAMINEI D ŞI CORELAȚII CLINICO-BIOLOGICE LA UN LOT DE PACIENȚI CU SCLEROZĂ SISTEMICĂ. |
| Alternate Title: |
Vitamin D and clinico-biological correlations in a group of patients with systemic sclerosis. |
| Authors: |
Groseanu, Laura1 laura_groseanu@yahoo.com, Berghea, Florian1, Bălănescu, Andra1, Predețeanu, Denisa1, Bojincă, Violeta1, Săulescu, Ioana1, Constantinescu, Cosmin1, Opriş, Daniela1, Abobului, Mihai1, Borangiu, Andreea1, Negru, Maria-Magdalena1, Vlad, Violeta1, Ionescu, Ruxandra1 |
| Source: |
Romanian Journal of Rheumatology / Revista Romana de Reumatologie. 2013, Vol. 22 Issue 2, p84-90. 7p. |
| Subject Terms: |
*VITAMIN D, *SYSTEMIC scleroderma, *EPIDEMIOLOGICAL research, *IMMUNOGLOBULINS, *AUTOIMMUNITY |
| Abstract (English): |
Background. Epidemiological evidence indicates a significant association between vitamin D deficiency and an increased incidence of several autoimmune diseases. Low vitamin D levels have also been reported in patients with systemic sclerosis (SSc), but the number of studies is limited with conflicting data. Objective. To investigate vitamin D status in a group of systemic sclerosis (SSc) patients and establish connections with markers of SSc disease activity and severity score, clinical and immunologic features Material. 51 scleroderma patients were evaluated during JAN 2010 - JAN 2013 in Internal Medicine and Rheumatology Department of Sf. Maria Hospital, Bucharest, Romania. We performed a complete evaluation of all patients following: MEDS evaluation sheets (cutaneous, musculoarticular, gastrointestinal, cardiac, pulmonary or renal involvement; inflammatory markers, autoantibodies, complement, capilaroscopy), DXA evaluation of osteoporosis, disease activity was evaluated with the Disease Activity Score (DAS) according to the European Scleroderma Study Group guidelines, HAQ (Health assessment questionnaires) have been also completed. Vitamin D was measured with the RIA Diasorin kit or expressed as "RIA Diasorin equivalent". Results: 92,15% of all patients were women, 50,98% had diffuse skin involvement, mean age 55,65 (SD 12,45) years, medium disease duration 11,7 years (SD 6,9), mean Rodnan 9,59 (SD 5,9), mean activity score = 3,43 (2,14), mean Medsger6,8. (SD 3,15), mean HAQ 0,8 (SD0,6). Mean vitamin D was 17,06 ng/ml (SD9,13). Only 4 patients had optimal levels of 25(OH)2 D; most of the patients had an insufficient (68,62%) or deficient (23,52%) level. Although levels below normal were found in most of the patients significant correlations of vitamin d status were found only muscle weakness (p = 0,000), muscle atrophy (p = 0,02), gastrointestinal involvement (p = 0,005) and the use of immunosuppressive drugs (p = 0,02).Pulmonary fibrosis seems to be more frecquent in patients with insufficient levels no matter of disease subtype (p = 0,03). Other correlations found for the patients with insufficiency were with anticentromere antibodies (p = 0,04), scleroderma renala crisis for female (p = 0,003) with long disease duration (p = 0,004), hipocomplementemia (p = 0,03) in the diffuse subtype, activity scale for females (p = 0,02). In patients with long disease duration correlations were found with TLCO (p = 0,04), Medsger score (p = 0,04). In patients with short disease duration correlations were found with activity score Conclusions. Vitamin D deficiency and insufficiency were no mather of subtype, disease duration, visceral involvement and vitamin D supplementation. This suggests that common vitamin D supplementation does not correct the deficiency in SSc patients, and that a higher dose is probably needed. We are aware of the limitations of the study that are: small group, lack of control group and the fact that measurements of vitamin D were not done in the same period of the year. Given the most recent findings, we consider further research would be clinically important to elucidate the causes of hypovitaminosis D in SSc, its relevance to disease progression, its influence on immune functions and the potential effects of supplementation. [ABSTRACT FROM AUTHOR] |
| Abstract (Romanian): |
Dovezi epidemiologice sugerează asocierea deficitului de vitamina D cu incidență crescută a unor boli autoimune. La pacienții cu sclerodeermie a fost raportat frecvent deficit de vitamină D, dar rezultatele studiilor sunt conflictuale. Obiectiv. Investigarea statusului vitamminei D la un lot de pacienți cu scleroză sistemică şi stabilirea corelațiilor cu markeri de activitate şi severitate, cu parametrii clinici şi imunologici ai bolii. Material. Au fost investigați 51 de pacienți cu sclerodermie internați între ianuarie 2010 şi ianuarie 2013 în Clinica de Medicină Internă şi Reumatologie a Spitalului Clinic Sf. Maria. Evaluările au fost făcute conform fişelor de evaluare MEDS (minimal essential data sheets): afectare cutanată, musculoarticulară, gastrointestinală, pulmonară, cardiacă şi renală, sindrom inflamator, autoanticorpi, complement, DXA, scorul de activitate al bolii conform European Study Group Guidelines, scorul de severitate al bolii Medsger şi HAQ (Health assessment questionnaires) au fost, de asemenea, completate. Vitamina D a fost determinată folosind kituri RIA Diasorin şi exprimată ca unități Diasorin. Rezultate. 92,15% erau femei, 50,98% subtip difuz, vârsta medie era 55,65 (SD 12,45) ani, durata medie a bolii 11,7 ani (SD 6,9), valoare medie Rodnan 9,59 (SD 5,9), valoarea medie scor de activitate 3,43 (2,14), valoarea medie Medsger 6,8. (SD 3,15), media HAQ 0,8 (SD0,6). Valoarea medie a nivelului seric de 25(OH)D a fost 17,06 ng/ml (SD9,13). Doar 4 pacienți aveau niveluri optime ale vitaminei D, 68,62% aveau nivel deficitar, 23,52% insuficiență. Deşi majoritatea pacienților aveau nivel suboptimal, corelații ale acesteia au fost identificate doar cu slăbiciunea musculară (p = 0,000), atrofia musculară (p = 0,02), afectarea gastrointestinal (p = 0,005) şi folosirea imunosupresoarelor (p = 0,02). Fibroza pulmonară pare să fie mai frecventă la cei cu nivel deficitar indiferent de subtipul bolii (p = 0,03). Au mai fost identificate corelații ale nivelului insuficient cu prezența anticorpilor anticentromer (p = 0,04), pentru sexul feminin cu criza renală sclerodermică (p = 0,003) cu durata îndelungată a bolii (p = 0,004),cu hipocomplementemia (p = 0,03) pentru forma difuză, cu scorul de activitate pentru femei (p = 0,02); pentru pacienții cu boală de lungă durată nivelul de vitamin D se corelează cu TLCO (p = 0,04), scor Medsger (p = 0,04); în cazul evoluției de scurtă durată se corelează doar cu scorul de activitate. Concluzii. Hipovitaminoza D este frecventă la pacienții cu scleroză sistemică indiferent de subip, durata bolii, afectarea viscerală sau aportul suplimentar. Deficitul nu se corectează cu dozele suplimentare uzuale, ceea ce sugerează necesitatea unui aport mai mare decât cel obişnuit. Limitările studiului sunt: numărul mic de pacienți, absența lotului control, măsurătorile vitaminei D nu au fost făcute în aceeaşi perioadă a anului. Considerăm însă oportună efectuarea de studii suplimentare care să elucideze cauzele hipovitaminozei, importanța în progresia bolii, influența asupra imunității şi efectele aportului suplimentar. [ABSTRACT FROM AUTHOR] |
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