Sistemik Sklerozlu Hastalarda D Vitamini Eksikliği Sıklığının Ve Hastalık Tutulumu ile İlişkisinin Değerlendirilmesi

Yıl 2023, Cilt: 15 Sayı: 1, 10 - 16, 30.04.2023

Kezban Armagan , Özgül Soysal Gündüz

https://doi.org/10.35514/mtd.2023.82

Öz

Amaç: Sistemik skleroz (SSk), vaskülopati, visseral ve kutanöz fibrozis ile karakterize kronik otoimmün bir hastalıktır. D vitamininin immünolojik sistemde çeşitli işlevleri vardır ve farklı çalışmalar otoimmün hastalıkları tetiklemede potansiyel bir rolü olduğunu göstermiştir. SSk'lı hastalar düşük serum D vitamini seviyeleri ile başvurabilirler, ancak vitamin D düşüklüğü ile hastalık ve klinik belirti arasındaki ilişki hala belirsizdir. Amacımız, sklerodermalı hastalarda D vitamini eksikliğinin sıklığını belirlemek ve D vitamini konsantrasyonu ile sistemik sklerozun organ tutulumu ile arasındaki ilişkileri analiz etmektir.
Gereç ve Yöntemler: Bu çalışmada retrospektif olarak 54 Sistemik skleroz tanılı hastanın dosyası tarandı. Kontrol grubu olarak da metabolik kemik hastalığı ve romatolojik öyküsü bulunmayan 50 sağlıklı gönüllü alındı. D vitamini durumu, 25-hidroksivitamin D serum seviyeleri ölçülerek değerlendirildi. Skleroderma hastaları alt grupları ve organ tutulumu açısından veriler analiz edildi.
Bulgular: Elli dört SSc hastası (49 kadın, ortalama yaş 53.25 ± 10.77 yıl ve hastalık süresi 8 (1-25) yıl) ve 50 kontrol (45 kadın, ortalama yaş 51.02 ± 9.14 yıl) dahil edildi. Sistemik skleroz grubunda ortalama D vitamini düzeyi 11.35 ± 4.09 ng/dL idi. Yedi hastada (%12.9) ağır D vitamini eksikliği (<5 ng/ml) ve 46 hastada (%85.1) D vitamini eksikliği (20 - 5 ng/ml) varken optimal yeterli D vitamini düzeyi saptanmadı. Sağlıklı kontrolle kıyasla hasta grubunda anlamlı olarak D vitamini düşüklüğü saptandı (p=0.001). Sistemik skleroz alt gruplarındaki analizde pulmoner tutulum (p=0.019) ve DLCO (p=0.023) dışında anlamlı fark yoktu. 25-hidroksivitamin D konsantrasyonu ile yaş, akut faz reaktanları, otoantikor profili, cilt tutulumunun derecesi, hastalık aktivitesi ve solunum testleri ile D vitamini arasındaki korelasyon bakıldı, anlamlı korelasyon saptanmadı.
Sonuç: Sistemik skleroz hastalarının serum D vitamini konsantrasyonları sağlıklı kontrollere göre anlamlı derecede daha düşüktü. Cilt tutulumu, hastalık aktivitesi ile 25-hidroksivitamin D düzeyi arasında ise anlamlı bir korelasyon saptanmadı

Anahtar Kelimeler

Sistemik skleroz, 25-hidroksivitamin D, cilt tutulumu, pulmoner tutulum

Destekleyen Kurum

Funding: The authors received no financial support for the research and/or authorship of this article.

Teşekkür

Çalışmaya katkıda bulunan tüm yazarlara teşekkür ederiz

Evaluation Of The Frequency Of Vitamin D Deficiency And Its Relationship With Disease Involvement In Patients With Systemic Sclerosis

Öz

Objective: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by vasculopathy, visceral and cutaneous fibrosis. Vitamin D has various functions in the immunological system and different studies have shown a potential role in triggering autoimmune diseases. Patients with SSc may present with low serum vitamin D levels, but the relationship between low vitamin D levels and disease and clinical manifestations is still unclear. Our aim is to determine the frequency of vitamin D deficiency in patients with scleroderma and to analyze the relationship between vitamin D concentration and organ involvement of systemic sclerosis.
Material and Methods: This study retrospectively scanned the files of 54 patients with systemic sclerosis and compared them with the control group. Serum levels of 25-hydroxyvitamin D were measured and the two groups and Systemic sclerosis subgroups were compared. Systemic sclerosis subgroups were also analyzed for organ involvement.
Results: Fifty-four SSc patients ( 49 females, mean age 53.25 ± 10.77 years, and the median disease duration 8 (1-25) years) and 50 controls (45 females, mean age 51.02 ± 9.14 years) were included. In the Systemic sclerosis group, 7 patients (12.9%) had severe vitamin D deficiency (<5 ng/ml) and 46 patients (85.1%) had vitamin D deficiency (20 - 5 ng/ml), while optimal vitamin D level was not found. There was a significant decrease in vitamin D in the patient group compared to the healthy control (p=0.001). There was no significant difference in the analysis of Systemic sclerosis subgroups except for pulmonary involvement (p=0.019) and DLCO (p=0.023).The correlation between 25-hydroxyvitamin D concentration and age, acute phase reactants, autoantibody profile, degree of skin involvement, disease activity and respiratory tests and vitamin D was not found.
Conclusion: Serum vitamin D concentrations of patients with SSc were significantly lower than healthy controls. There was no significant correlation between skin involvement, disease activity and 25-hydroxyvitamin D level.

Anahtar Kelimeler

Systemic sclerosis, 25-hydroxyvitamin D, skin involvement, pulmonary involvement

Kaynakça

• 1. Gu YS, Kong J, Cheema GS, Keen CL, Wick G, Gershwin ME, editors. The immunobiology of systemic sclerosis. Seminars in arthritis and rheumatism; 2008: Elsevier.
• 2. Bossini-Castillo L, López-Isac E, Martín J. Immunogenetics of systemic sclerosis: defining heritability, functional variants and shared-autoimmunity pathways. Journal of autoimmunity. 2015;64:53-65.
• 3. Zimmermann AF, Pizzichini MMM. Update on the etiopathogenesis of systemic sclerosis. Revista Brasileira de Reumatologia (English Edition). 2013;53(6):516-524.
• 4. Fidan F, Alkan BM, Tosun A. Pandemic era: vitamin D deficiency and insufficiency. 2014.
• 5. Umar M, Sastry KS, Chouchane AI. Role of vitamin D beyond the skeletal function: a review of the molecular and clinical studies. International journal of molecular sciences. 2018;19(6):1618.
• 6. Antico A, Tampoia M, Tozzoli R, Bizzaro N. Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature. Autoimmunity reviews. 2012;12(2):127-136.
• 7. Sezgin G, Ozturk G, Turkal R, Caykara B. Vitamin D levels of outpatients admitted to a University Hospital in the Marmara Region of Turkey over 3 years. Journal of Medical Biochemistry. 2019;38(2):181.
• 8. Giuggioli D, Colaci M, Cassone G, Fallahi P, Lumetti F, Spinella A, et al. Serum 25-OH vitamin D levels in systemic sclerosis: analysis of 140 patients and review of the literature. Clinical rheumatology. 2017;36(3):583-590.
• 9. Artaza JN, Norris KC. Vitamin D reduces the expression of collagen and key profibrotic factors by inducing an antifibrotic phenotype in mesenchymal multipotent cells. Journal of Endocrinology. 2009;200(2):207-221.
• 10. Bivona G, Agnello L, Pivetti A, Milano S, Scazzone C, Sasso BL, et al. Association between hypovitaminosis D and systemic sclerosis: true or fake? Clinica Chimica Acta. 2016;458:115-119.
• 11. Holick MF. Vitamin D deficiency. New England journal of medicine. 2007;357(3):266-281.
• 12. Khanna D, Furst DE, Clements PJ, Allanore Y, Baron M, Czirjak L, et al. Standardization of the modified Rodnan skin score for use in clinical trials of systemic sclerosis. Journal of scleroderma and related disorders. 2017;2(1):11-18.
• 13. Hudson M, Steele R, Baron M, Group CSR, editors. Update on indices of disease activity in systemic sclerosis. Seminars in arthritis and rheumatism; 2007: Elsevier.
• 14. Öngen B, Kabaroğlu C, Parıldar Z. Vitamini’nin biyokimyasal ve laboratuvar değerlendirmesi. Türk klinik biyokimya dergisi. 2008;6(1):23-31.
• 15. Pludowski P, Holick MF, Pilz S, Wagner CL, Hollis BW, Grant WB, et al. Vitamin D effects on musculoskeletal health, immunity, autoimmunity, cardiovascular disease, cancer, fertility, pregnancy, dementia and mortality—a review of recent evidence. Autoimmunity reviews. 2013;12(10):976-989.
• 16. Ishikawa LLW, Colavite PM, Fraga-Silva TFdC, Mimura LAN, França TGD, Zorzella-Pezavento SFG, et al. Vitamin D deficiency and rheumatoid arthritis. Clinical reviews in allergy & immunology. 2017;52(3):373-388.
• 17. Caramaschi P, Dalla Gassa A, Ruzzenente O, Volpe A, Ravagnani V, Tinazzi I, et al. Very low levels of vitamin D in systemic sclerosis patients. Clin Rheumatol. 2010;29(12):1419-1425.
• 18. Waldron JL, Ashby HL, Cornes MP, Bechervaise J, Razavi C, Thomas OL, et al. Vitamin D: a negative acute phase reactant. J Clin Pathol. 2013;66(7):620-622.
• 19. Patel S, Farragher T, Berry J, Bunn D, Silman A, Symmons D. Association between serum vitamin D metabolite levels and disease activity in patients with early inflammatory polyarthritis. Arthritis Rheum. 2007;56(7):2143-2149.
• 20. Trombetta AC, Smith V, Gotelli E, Ghio M, Paolino S, Pizzorni C, et al. Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments. PLoS One. 2017;12(6):e0179062.
• 21. Arnson Y, Amital H, Agmon-Levin N, Alon D, Sánchez-Castañón M, López-Hoyos M, et al. Serum 25-OH vitamin D concentrations are linked with various clinical aspects in patients with systemic sclerosis: a retrospective cohort study and review of the literature. Autoimmun Rev. 2011;10(8):490-494.
• 22. Vacca A, Cormier C, Piras M, Mathieu A, Kahan A, Allanore Y. Vitamin D deficiency and insufficiency in 2 independent cohorts of patients with systemic sclerosis. J Rheumatol. 2009 Sep;36(9):1924-1929. doi: 10.3899/jrheum.081287. Epub 2009 Jul 31. PMID: 19648299.
• 23. Caimmi C, Bertoldo E, Pozza A, Caramaschi P, Orsolini G, Gatti D, et al. Vitamin D serum levels and the risk of digital ulcers in systemic sclerosis: A longitudinal study. Int J Rheum Dis. 2019;22(6):1041-1045.
• 24. An L, Sun MH, Chen F, Li JR. Vitamin D levels in systemic sclerosis patients: a meta-analysis. Drug Des Devel Ther. 2017;11:3119-3125.
• 25. Diaconu AD, Ostafie I, Ceasovschih A, Șorodoc V, Lionte C, Ancuța C, et al. Role of Vitamin D in Systemic Sclerosis: A Systematic Literature Review. J Immunol Res. 2021;2021:9782994.
• 26. Hax V, Gasparin AA, Schneider L, Monticielo OA, Soares HMF, do Amaral Streit M, et al. Vitamin D and cytokine profiles in patients with systemic sclerosis. JCR: Journal of Clinical Rheumatology. 2020;26(7):289-294.
• 27. Desai CS, Lee DC, Shah SJ. Systemic sclerosis and the heart: current diagnosis and management. Curr Opin Rheumatol. 2011;23(6):545-554.
• 28. Ramirez AM, Wongtrakool C, Welch T, Steinmeyer A, Zügel U, Roman J. Vitamin D inhibition of pro-fibrotic effects of transforming growth factor beta1 in lung fibroblasts and epithelial cells. J Steroid Biochem Mol Biol. 2010;118(3):142-150.
• 29. Atteritano M, Santoro D, Corallo G, Visalli E, Buemi M, Catalano A, et al. Skin Involvement and Pulmonary Hypertension Are Associated with Vitamin D Insufficiency in Scleroderma. Int J Mol Sci. 2016;17(12).
• 30. Schneider L, Hax V, Monticielo O, Macedo TF, Barreto RKM, Marcondes NA, et al. Dualities of the vitamin D in systemic sclerosis: a systematic literature review. Adv Rheumatol. 2021;61(1):34.
• 31. Gupta S, Mahajan VK, Yadav RS, Mehta KS, Bhushan S, Chauhan PS, et al. Evaluation of Serum Vitamin D Levels in Patients with Systemic Sclerosis and Healthy Controls: Results of a Pilot Study. Indian Dermatol Online J. 2018;9(4):250-255.