Clinical Rheumatology

, Volume 37, Issue 10, pp 2685–2692 | Cite as

Serum 25-hydroxyvitamin D3 levels and flares of systemic lupus erythematosus: a longitudinal cohort analysis

  • Chi Chiu MokEmail author
  • Eric T. Bro
  • Ling Yin Ho
  • Ravinder J. Singh
  • Paul J. Jannetto
Original Article


The aim of this study is to evaluate the relationship between baseline serum 25-hydroxyvitamin D3 levels and SLE activity/flares over time. This is a longitudinal study of 276 patients who fulfilled ≥ 4 ACR criteria for SLE and recruited in the year 2011. Serum samples were collected at baseline and assayed for 25-hydroxyvitamin D3 at the end of a mean follow-up of 32.5 months. Participants were stratified into three groups according to baseline 25-hydroxyvitamin D3 levels: group I (< 15 ng/ml, deficiency), group II (15–30 ng/ml, insufficiency), and group III (> 30 ng/ml, adequate). Baseline and summated SLE disease activity index (SLEDAI) score over time and the annual incidence of lupus flares were compared among these groups. 25-hydroxyvitamin D3 levels of < 15, 15–30, and > 30 ng/ml were present in 26, 54, and 20% of the recruited patients, respectively. Group I had significantly higher baseline SLEDAI scores. After a follow-up of 32.5 ± 5.5 months, 153 mild/moderate and 91 severe flares developed. The mean summated SLEDAI was 3.2 ± 2.0 in group I, 2.4 ± 1.9 in group II and 2.7 ± 2.1 in group III patients (P = 0.02). The annual incidence of mild/moderate and severe flares was 0.26 ± 0.39 and 0.20 ± 0.45 (group I); 0.20 ± 0.33 and 0.09 ± 0.22 (group II); and 0.20 ± 0.32 and 0.14 ± 0.46 (group III), respectively (P > 0.05). In a subgroup of 73 patients who were clinically and serologically quiescent at baseline, a similar trend of more flares was observed in group I patients. Vitamin D deficiency was frequent in Chinese SLE patients and was associated with more active disease at baseline and over time, as well as a trend of more severe lupus flares.


Cholecalciferol Damage Disease activity Flares Vitamin D 


Grant support


Author contribution

All the authors have contributed substantially to this work.

Compliance with ethical standards

Ethics and consent

Written consent was obtained from all the participants, and this study was approved by the Ethics Committee of our hospital.




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Copyright information

© International League of Associations for Rheumatology (ILAR) 2018

Authors and Affiliations

  • Chi Chiu Mok
    • 1
    Email author
  • Eric T. Bro
    • 2
  • Ling Yin Ho
    • 1
  • Ravinder J. Singh
    • 2
  • Paul J. Jannetto
    • 2
  1. 1.Department of MedicineTuen Mun HospitalHong KongChina
  2. 2.Department of Laboratory Medicine and PathologyMayo ClinicRochesterUSA

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