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Serum vitamin D level correlates with disease activity and health-related quality of life in antineutrophil cytoplasmic antibody-associated vasculitis

Serum-Vitamin-D-Spiegel korreliert mit Krankheitsaktivität und gesundheitsbezogener Lebensqualität bei antineutrophile-zytoplasmatische-Antikörper-assoziierter Vaskulitis

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Abstract

Background and objective

The association between vitamin D levels and disease activity has been established in patients with several autoimmune rheumatic diseases. We aimed to examine the association between vitamin D and disease activity of antineutrophil cytoplasmic antibody-associated vasculitis (AAV).

Methods

Fifty-four AAV patients and 50 age- and sex-matched healthy controls without vitamin D supplements were included. Clinical and laboratory data were evaluated during the assessment of vitamin D levels. Two different forms of vitamin D in the sera—25(OH)D, which is the sum of 25(OH)D2 and 25(OH)D3, and 25(OH)D3, which only includes 25(OH)D in its D3 form—were measured, and the relationship between vitamin D and the obtained data was assessed. Variations in vitamin D levels relative to the season were also evaluated.

Results

Patients with AAV demonstrated considerably lower 25(OH)D serum levels than healthy controls (16.0 vs. 20.4 ng/mL, p = 0.016), and the proportion of individuals with vitamin D deficiency was higher in patients with AAV than in healthy controls (68.5% vs. 48.0%, p = 0.035). Both serum 25(OH)D and 25(OH)D3 were positively associated with the 36-item Short-form Health Survey (SF-36) physical component summary and SF-36 mental component summary (MCS) scores. A negative correlation was observed between 25(OH)D and 25(OH)D3 serum levels and Birmingham vasculitis activity score (BVAS), C‑reactive protein (CRP), and white blood cell count. Linear regression analysis indicated haemoglobin and 25(OH)D levels to be independently associated with BVAS and CRP and 25(OH)D levels with SF-36 MCS score. No seasonal variations were observed in vitamin D levels.

Conclusion

The results from this study suggest that vitamin D levels could provide clinically useful information in AAV.

Zusammenfassung

Hintergrund und Ziel

Der Zusammenhang zwischen dem Vitamin-D-Spiegel und der Krankheitsaktivität ist bei Patienten mit verschiedenen rheumatischen Autoimmunerkrankungen nachgewiesen worden. Ziel der Studie war es, den Zusammenhang zwischen Vitamin-D-Spiegel und Krankheitsaktivität bei der antineutrophile-zytoplasmatische-Antikörper-assoziierten Vaskulitis (AAV) zu untersuchen.

Methoden

In die Studie wurden 54 AAV-Patienten und 50 in Alter und Geschlecht damit übereinstimmende gesunde Kontrollen ohne Vitamin-D-Substitution einbezogen. Bei der Untersuchung der Vitamin-D-Spiegel wurden auch klinische und weitere Labordaten erhoben. Es wurden 2 verschiedene Formen von Vitamin D im Serum gemessen – 25(OH)D, welches 25(OH)D2 und 25(OH)D3 umfasst, und 25(OH)D3, welches nur das 25(OH)D in seiner D3-Form einschließt, – und der Zusammenhang zwischen Vitamin D und den ermittelten Daten beurteilt. Auch Schwankungen bei den Vitamin-D-Spiegeln in Abhängigkeit von der Jahreszeit wurden untersucht.

Ergebnisse

Patienten mit AAV wiesen deutlich geringere 25(OH)D-Spiegel im Serum auf als gesunde Kontrollen (16,0 vs. 20,4 ng/ml; p = 0,016), und der Anteil von Personen mit Vitamin-D-Mangel war bei AAV-Patienten höher als bei gesunden Kontrollen (68,5 vs. 48,0%; p = 0,035). Sowohl Serum-25(OH)D als auch -25(OH)D3 waren positiv mit dem Score der zusammengefassten körperlichen Komponente des 36-Item Short-Form Health Survey (SF-36) und der zusammengefassten psychischen Komponente (MCS) des SF-36 korreliert. Eine negative Korrelation fand sich zwischen den Serumwerten für 25(OH)D und 25(OH)D3 sowie dem Birmingham Vasculitis Activity Score (BVAS), C‑reaktivem Protein (CRP) und der Leukozytenzahl. Die lineare Regressionsanalyse zeigte, dass Hämoglobin- sowie 25(OH)D-Spiegel in unabhängiger Weise mit dem BVAS und CRP sowie 25(OH)D-Spiegel mit dem SF-36-MCS-Score korreliert waren. Jahreszeitliche Schwankungen wurden nicht beim Vitamin-D-Spiegel festgestellt.

Schlussfolgerung

Den Ergebnissen der vorliegenden Studie zufolge könnte der Vitamin-D-Spiegel klinisch nützliche Informationen bei AAV liefern.

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Funding

This research was supported by a faculty research grant of Yonsei University College of Medicine (6-2019-0184) and a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (HI14C1324).

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Authors and Affiliations

  1. Department of Medical Science, BK21 Plus Project, Yonsei University, College of Medicine, Seoul, Korea (Republic of)

    T. Yoon

  2. Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun–gu, 03722, Seoul, Korea (Republic of)

    S. S. Ahn, J. Y. Pyo, J. J. Song, Y.-B. Park & S.-W. Lee MD, PhD

  3. Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    J. J. Song, Y.-B. Park & S.-W. Lee MD, PhD

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  1. T. Yoon
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Correspondence to S.-W. Lee MD, PhD.

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Conflict of interest

T. Yoon, S. S. Ahn, J. Y. Pyo, J. J. Song, Y.-B. Park and S.-W. Lee declare that they have no competing interests.

All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. Approval was granted by the Ethics Committee of Severance Hospital (4-2016-0901). Informed consent was obtained from all individual participants included in the study.

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U. Müller-Ladner, Bad Nauheim

U. Lange, Bad Nauheim

Availability of data and material

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

T. Yoon and S. S. Ahn contributed equally to this work.

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Yoon, T., Ahn, S.S., Pyo, J.Y. et al. Serum vitamin D level correlates with disease activity and health-related quality of life in antineutrophil cytoplasmic antibody-associated vasculitis. Z Rheumatol 81, 77–84 (2022). https://doi.org/10.1007/s00393-020-00949-2

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