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Low Vitamin D strongly associated with Systemic Sclerosis, a rare disease

Systemic sclerosis and Vitamin D literature review (97% had <20 ng)– Jan 2017

Serum 25-OH vitamin D levels in systemic sclerosis: analysis of 140 patients and review of the literature
Clinical Rheumatology, pp 1–8, Online: 09 January 2017, DOI: 10.1007/s10067-016-3535-z
Dilia GiuggioliEmail authorM. ColaciG. CassoneP. FallahiF. LumettiA. SpinellaF. CampomoriA. ManfrediC. U. ManziniA. AntonelliC. Ferri

Hypovitaminosis D is increasingly reported in autoimmune diseases. We investigated the 25-OH-vitamin D (25-OH-vitD) levels in systemic sclerosis (SSc) patients, in correlation with disease’s features. We measured the 25-OH-vitD serum levels in 140 consecutive patients (F/M 126/15; mean age 61 ± 15.1 years), 91 without (group A ) and 49 with (group B ) 25-OH-cholecalciferol supplementation. Patients of group A invariably showed low 25-OH-vitD levels (9.8 ± 4.1 ng/ml vs. 26 ± 8.1 ng/ml of group B ); in particular, 88/91 (97%) patients showed vitamin D deficiency (<20 ng/ml), with very low vitamin D levels (<10 ng/ml) in 40 (44%) subjects. Only 15/49 (30.6%) patients of group B reached normal levels of 25-OH-vitD (=30 ng/ml), whereas vitamin D deficiency persisted in 12/49 (24.5%) individuals. Parathormone levels inversely correlated with 25-OH-vitD (r = -0.3, p < 0.0001). Of interest, hypovitaminosis D was statistically associated with autoimmune thyroiditis (p = 0.008), while calcinosis was more frequently observed in patients of group A (p = 0.057). Moreover, we found significantly higher percentage of serum anticentromere antibodies in group B patients with 25-OH-vitD level =30 ng/ml (8/15 vs. 6/34; p = 0.017).
In literature, hypovitaminosis D is very frequent in SSc patients. An association with disease duration, calcinosis, or severity of pulmonary involvement was occasionally recognized. Hypovitaminosis D is very frequent in SSc and severe in a relevant percentage of patients; furthermore, less than one third of supplemented subjects reached normal levels of 25-OH-vitD. The evaluation of 25-OH-vitD levels should be included in the routine clinical work-up of SSc. The above findings expand previous observations and may stimulate further investigations.

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Systemic sclerosis and low vitamin D – June 2016

Low vitamin D status in systemic sclerosis and the impact on disease phenotype.
Eur J Rheumatol. 2016 Jun;3(2):50-55. Epub 2016 Feb 1.
Groseanu L1, Bojinca V1, Gudu T2, Saulescu I1, Predeteanu D1, Balanescu A1, Berghea F1, Opris D1, Borangiu A1, Constantinescu C1, Negru M1, Ionescu R1.
1Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
2Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
Most people with Systemic sclerosis have < 30 ng of vitamin D
Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis.
Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels.
The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels.
No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29).
Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.

PMID: 27708971 DOI: 10.5152/eurjrheum.2015.0065
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Very low levels of vitamin D in systemic sclerosis patients - May 2010

Clin Rheumatol. 2010 May 9. Epub ahead of print
Caramaschi P, Dalla Gassa A, Ruzzenente O, Volpe A, Ravagnani V, Tinazzi I, Barausse G, Bambara LM, Biasi D.
Dipartimento di Medicina Clinica e Sperimentale, Università di Verona, Verona, Italy, paola.caramaschi at ospedaleuniverona.it.

Vitamin D displays many extraosseous immunomodulatory effects. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis (SSc) and to analyze the associations between the concentration of the vitamin and clinical manifestations. In March-April 2009, 65 consecutive SSc patients underwent evaluation of vitamin D concentrations by the LIAISON immunoassay (normal 30-100 ng/ml).

Serum levels between 10 and 30 ng/ml were classified as vitamin D insufficiency, while concentrations <10 ng/ml as vitamin D deficiency. None of the patients were receiving vitamin D supplementation at the time of or during the year prior to study entry. The mean level of vitamin D was 15.8 +/- 9.1 ng/ml. Only three cases showed normal values; vitamin D insufficiency and deficiency were found in 43 and 19 cases, respectively.

Patients with vitamin D deficiency showed longer disease duration (13.1 +/- 6.8 versus 9.4 +/- 5.5 years, P = 0.026), lower diffusing lung capacity for carbon monoxide (63.7 +/- 12.4 versus 76.4 +/- 20.2, P = 0.014), higher estimated pulmonary artery pressure (28.9 +/- 9.9 versus 22.8 +/- 10.4, P = 0.037) and higher values of ESR (40 +/- 25 versus 23 +/- 13 mm/h, P = 0.001) and of CRP (7 +/- 7 and 4 +/- 2 mg/l, P = 0.004) in comparison with patients with vitamin D insufficiency; moreover, late nailfold videocapillaroscopic pattern was more frequently found (52.6% versus 18.6%, P = 0.013). None of the patients showed evidence of overt mal-absorption. Low levels of vitamin D are very frequent in patients with SSc. Intestinal involvement is not likely the cause of vitamin D deficit; other factors such as skin hyperpigmentation and reduced sun exposition for psychological and social reasons may be implicated. Patients with vitamin D deficiency showed more severe disease in comparison with patients with vitamin D insufficiency, above all concerning lung involvement. Further trials are awaited to determine whether vitamin D could represent a modifiable factor able to interfere with SSc evolution. PMID: 20454816

Extraosseous = outside of the bone
Systemic sclerosis = rare, chronic disease which affects not only the skin and underlying tissues, but also affects the blood vessels and major organs of the body. Two types of systemic disease are recognized: limited and diffuse.

Vitamin D only 13 ng for people having systemic sclerosis – Review June 2011

!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 Jun;10(8):490-4. Epub 2011 Feb 12.
Arnson Y, Amital H, Agmon-Levin N, Alon D, Sánchez-Castañón M, López-Hoyos M, Matucci-Cerinic M, Szücs G, Shapira Y, Szekanecz Z, Shoenfeld Y.
Department of Medicine D, Meir Medical Center, Kfar Saba, Israel.

Low vitamin D serum concentrations have been reported in several autoimmune conditions. The study's aim was to explore such a relationship in a large multinational population of patients with systemic sclerosis (SSc) and to pursue possible clinical and laboratory correlates with vitamin D concentrations. 327 sera samples of European patients with SSc and 141 samples of compatible healthy controls were studied for vitamin D concentrations using the commercial kit LIAISON 25-OH vitamin D assay (Diasorin). Additionally, clinical parameters including the Rodnan skin score, diffusing lung capacity for carbon monoxide (DLCO), systolic pulmonary artery pressure (sPAP), forced vital capacity (FVC), and nailfold video capillaroscopic, erythrocyte sedimentation rate (ESR), anti-nuclear antibodies (ANA and scl70), rheumatoid factor (RF) were investigated.

Vitamin D serum concentration was 13.5 ± 9.0 ng/ml (mean ± standard deviation) in patients with SSc compared to 21.6 ± 9.7 ng/ml in a control group (p<0.001). A negative correlation between patients' age and vitamin D concentration (r = -0.2, p<0.05, n = 96) was observed. An inverse relationship was found between skin involvement and vitamin D serum concentrations; Patients with a Rodnan skin score of 10 or lower (n = 11) had a mean vitamin D concentration of 17.7 ± 10.4 ng/ml compared to patients with a score above 10 (n = 28) 8 ± 10.1 ng/ml (p=0.02, by the Mann-Whitney test).

In conclusion, Patients with SSc have significantly lower serum vitamin D concentrations compared to healthy controls; moreover fibrosis of the cutaneous tissue is inversely related to the vitamin D concentration.

Copyright © 2011. Published by Elsevier B.V. PMID: 21320645

Systemic sclerosis Vit D: Low, varied with season, not change with 1,000 IU – June 2017

Vitamin D deficiency and clinical correlations in systemic sclerosis patients: A retrospective analysis for possible future developments.
PLoS One. 2017 Jun 9;12(6):e0179062. doi: 10.1371/journal.pone.0179062. eCollection 2017.
Trombetta AC1, Smith V2, Gotelli E1, Ghio M1, Paolino S1, Pizzorni C1, Vanhaecke A2, Ruaro B1, Sulli A1, Cutolo M1.

Average 25(OH)D serum concentration was 18.7 ±9 ng/ml (<20 classified as deficiency). A significant correlation was found with presence/absence of lung bi-basal fibrotic changes (16.1 ±8 ng/ml and 20 ±10 ng/ml, respectively; p = 0.04). Peripheral vascular (p = 0.03), kidney (p = 0.02), gastrointestinal (p = 0.05) Medsger's DSS parameters were found to correlate with 25(OH)D serum concentrations. No significant correlations were observed with digital ulcers incidence, strictly correlated to patterns of microangiopathy, defined at NVC analysis (p<0.0001). Interestingly, no effects of treatment with oral colecalciferol (Dibase 1,000 IU daily for at least 6 months) were found on 25(OH)D serum concentrations in treated (18.8 ±10 ng/ml) or untreated (18.7 ±9 ng/ml) SSc patients (p = 0.81). A significant difference was observed among seasonal 25(OH)D serum concentrations (winter: 14.6 ±7.8 ng/ml, spring: 17.2 ±7.9 ng/ml, summer: 21.43 ±10 ng/ml, autumn: 20.2 ±10 ng/ml; p = 0.032) in all patients.

Serum 25(OH)D deficiency was found to correlate with lung involvement, peripheral vascular, kidney and gastrointestinal Medsger's DSS parameters and with seasonality In SSc patients. Supplementation with oral colecalciferol was found not effective in increasing 25(OH)D serum concentrations. Therefore, for successful replacement, supra-physiological vitamin D3 doses or programmed UVB light exposure should be tested.
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Systemic Sclerosis + Raynaud’s => other health problems - 2016

Many Systemic Sclerosis Patients with Raynaud’s Syndrome Soon Develop Other Conditions Oct 2016

  • "Of the initial 9,891 SSc patients followed during the EUSTAR study, 695 patients with a median age of 52.7 years had a baseline visit within one year after Raynaud’s onset, and developed skin sclerosis (75%); GI symptoms (71%); impaired diffusing capacity for monoxide below 80% (65%); DU (34%); cardiac involvement (32%); FVC below 80% (31%); increased PAPsys (14%); and renal crisis (3%)."

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See also web

  • http://www.scleroderma.org
    “The word “scleroderma” comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin. Hardening of the skin is one of the most visible manifestations of the disease.”
    “It’s estimated that about 300,000 Americans have scleroderma. About one third of those people have the systemic form of scleroderma.”
    “Overall, female patients outnumber male patients about 4-to-1.”
    “It is known that scleroderma involves an overproduction of collagen”
    “Systemic scleroderma can involve the skin, esophagus, gastrointestinal tract (stomach and bowels), lungs, kidneys, heart and other internal organs. It can also affect blood vessels, muscles and joints.”

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Attached files

ID Name Comment Uploaded Size Downloads
8089 systemic sclerosis PLOS.pdf PDF 2017 admin 10 Jun, 2017 13:21 2.77 Mb 347
8068 ss.jpg admin 06 Jun, 2017 15:42 19.08 Kb 1598
7154 Scleroderma tree.jpg admin 07 Oct, 2016 14:13 17.00 Kb 1860
7153 Scleroderma spectrum.jpg admin 07 Oct, 2016 14:13 34.21 Kb 6708
7152 Systemic scleroderma.pdf PDF 2016 admin 07 Oct, 2016 14:11 125.49 Kb 483
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