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Low Vitamin D strongly associated with Systemic Sclerosis - many studies

Vitamin D in Systemic Sclerosis: A Review - 2022

Nutrients 2022, 14(19), 3908; https://doi.org/10.3390/nu14193908
first author Mattia Perazzi

Background: In the present paper we aimed to review the evidence about the potential implication of vitamin D in the pathogenesis and management of systemic sclerosis (SSc);

Methods: we performed a review of the literature looking for studies evaluating the potential role of vitamin D and its analogs in SSc. We searched the PubMed, Medline, Embase, and Cochrane libraries using the following strings: (vitamin D OR cholecalciferol) AND (systemic sclerosis OR scleroderma). We included cohort studies, case-control studies, randomized controlled trials, and observational studies.

Results: we identified nine pre-clinical and 21 clinical studies. Pre-clinical data suggest that vitamin D and its analogs may suppress fibrogenesis. Clinical data are concordant in reporting a high prevalence of hypovitaminosis D and osteoporosis in SSc patients; data about the association with clinical manifestations and phenotypes of SSc are, conversely, far less consistent;

Conclusions: in vitro data suggest that vitamin D may play an antifibrotic role in SSc, but clinical data confirming this finding are currently lacking. Hypovitaminosis D is common among SSc patients and should be treated to reduce the risk of osteoporosis
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Systemic Sclerosis review (SS associated with low Vitamin D) Nov 2021

Role of Vitamin D in Systemic Sclerosis: A Systematic Literature Review
Alexandra-Diana Diaconu ,1 Iustina Ostafie ,1 Alexandr Ceasovschih ,2,3 Victorița Șorodoc ,2,3 Cătălina Lionte ,2,3 Codrina Ancuța ,1,3 and Laurențiu Șorodoc 2,3

Background. Systemic sclerosis (SSc) is a chronic multisystem autoimmune condition defined by a complex pathobiology, comprising excessive fibrosis of skin and internal organs, peripheral vasculopathy with endothelial cell dysfunction, inadequate vascular repair and neovascularization, and aberrant immunity. Vitamin D is a steroid hormone with pleiotropic effects beyond its traditional role in calcium and bone homeostasis. Since vitamin D has immunomodulatory, cardioprotective, and antifibrotic properties, it could potentially interfere with SSc pathogenesis. Suboptimal vitamin D levels are classically recognized in scleroderma, irrespective of clinical and serological phenotype. Aim. This systematic review is aimed at investigating and clarifying the role of vitamin D in SSc and emphasizing the association of vitamin D status with different clinical settings.

Methods and Results. A systematic online search was performed, using PubMed databases to collect articles on the topic of vitamin D in SSc. The final analysis included 40 eligible articles.

Conclusions. Hypovitaminosis D is common in SSc patients and could be associated with clinical and serologic patterns of the disease. Intervention for low serum vitamin D levels in SSc pathogenesis remains controversial, as well as the significance of vitamin D supplementation in such patients.
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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.

Publisher wants $40 for the PDF, but the references online are free

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.
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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%)."

See also VitaminDWiki

VitaminDWiki - Autoimmune

VitaminDWiki studies in both Autoimmune and Vitamin D Receptor categories

8,640 studies of "Systemic Sclerosis" "vitamin d" in google Scholar as of Nov 2021

google Scholar

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
18459 SS Review.pdf PDF 2022 admin 21 Sep, 2022 17:57 507.27 Kb 5
16664 Systemic Sclerosis review.pdf PDF 2021 admin 29 Nov, 2021 16:42 1.07 Mb 112
8089 systemic sclerosis PLOS.pdf PDF 2017 admin 10 Jun, 2017 13:21 2.77 Mb 491
8068 ss.jpg admin 06 Jun, 2017 15:42 19.08 Kb 2005
7154 Scleroderma tree.jpg admin 07 Oct, 2016 14:13 17.00 Kb 2240
7153 Scleroderma spectrum.jpg admin 07 Oct, 2016 14:13 34.21 Kb 7315
7152 Systemic scleroderma.pdf PDF 2016 admin 07 Oct, 2016 14:11 125.49 Kb 638
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