Vitamin D and antiphospholipid syndrome: A retrospective cohort study and meta-analysis
Seminars in Arthritis and Rheumatism, online 12 October 2017, https://doi.org/10.1016/j.semarthrit.2017.10.007
Leyre Riancho-Zarrabeitiaa, 1, Maite Cuberíaa, Pedro Muñoze, Marcos López-Hoyosb, Silvia García-Canalea, Mayte García-Unzuetac, José L. Hernándezd, Víctor M. Martínez-Taboadaa, ,
- a) To determine serum 25-OH vitamin D (vitD) levels in primary antiphospholipid syndrome (APS) and to compare them with patients with positive antiphospholipid serology who do not meet clinical criteria for APS, and with healthy controls.
- b) To analyze the association of vitD levels with both the clinical manifestations and the immunological profile of patients with primary APS.
- c) To perform a meta-analysis evaluating potential differences in serum vitD levels between APS and controls as well as the frequency of vit D deficiency in APS patients.
Retrospective study including 74 patients with primary APS, 54 with positive antiphospholipid (aPL) serology not meeting clinical criteria for APS and 215 healthy controls. We considered 30 ng/ml and 10 ng/ml as the thresholds for vitamin D insufficiency and deficiency, respectively. Meta-analysis included 4 case-control studies (325 primary APS patients and 507 controls) and was conducted by fitting random effects models and checked for heterogeneity.
Median serum vitD levels were similar in the three groups: 21 ng/ml in primary APS, 25 ng/ml in the aPL-positive group, and 21 ng/ml in controls (p=0.115). However, we found differences in the PTH levels, being 40.4 ± 24.9 pg/ml in APS, 34.1 ± 18.2 pg/ml in aPL serology and 23.4 ±12.6 pg/ml in healthy controls (p<0.001). Regarding vitamin D deficiency, we found significant differences across the groups: 16.2% in APS, 11.1% in patients with positive serology and 3.7% in controls (p=0.001). There was a trend for the presence of thrombotic events in patients with vitamin D deficiency (38.9% vs 19.1%, p=0.071).
The meta-analysis confirmed that the combined mean difference in serum vitD levels between APS and controls was −3.605 (p <0.001) and that APS patients had an increased frequency of vitD deficiency, with an OR 3.06 (95% CI 2.12 − 4.43, p<0.001).
APS patients show higher frequency of vitD deficiency than the healthy individuals. The meta-analysis study, including three cohorts and ours, suggests that APS patients have significantly lower serum vitD levels and higher frequency of vitD deficiency than controls.
Vitamin D and Anti-Phospholipid Antibody Syndrome: A Comprehensive Review
Roberta Gualtierotti1, 2, *, Alessio Di Giacomo3, Elena Raschi3, Maria Orietta Borghi2, 3, Pier Luigi Meroni3
1 Lupus Clinic, Department of Rheumatology and Clinical Sciences, ASST Pini-CTO, Milan, Italy
2 Department of Clinical Sciences and Community Health, University of Milan, P.za Cardinal Ferrari, 1 20122, Milan, Italy
3 Immunorheumatology Research Laboratory, Instituto Auxologico Italiano, IRCCS, Milan, Italy
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Vitamin D is a steroid hormone that exerts a variety of biological effects that range from the well-known regulation of bone metabolism to the modulation of cellular growth, of apoptosis, and the regulation of both innate and adaptive immunity. Evidence supports a correlation between low vitamin D levels and a high risk to develop chronic inflammatory diseases including autoimmune diseases.
Anti-phospholipid antibody (aPL) syndrome (APS) is an autoimmune chronic condition characterized by recurrent arterial and/or venous thrombosis and/or obstetric complications associated with persistent aPL positivity. Secondary prevention of thrombosis is widely accepted in these patients and relies on life-long anticoagulant drugs. On the contrary, primary prevention in isolated aPL positivity in healthy carriers and treatment of obstetric manifestations in APS are still debated.
Epidemiological data have shown that vitamin D deficiency (serum levels <30 ng/ml) is frequent in APS patients and that it may be associated with an increased risk of thrombosis in these patients. Experimental data show that vitamin D is able to reduce the expression of adhesion molecules, of toll-like receptors and the secretion of proinflammatory chemokines, thus playing a protective role on endothelial activation and the subsequent development of thrombosis in APS.
Although these observations need to be confirmed in prospective studies and randomized clinical trials, it is tempting to speculate that vitamin D supplementation could be very useful for the prevention of clinical manifestations in APS patients, in particular as a primary prevention countermeasure in aPL carriers.
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Autoimmune category starts with
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antiphospholipid syndrome Wikipedia
- “Antiphospholipid syndrome or antiphospholipid antibody syndrome (APS or APLS), is an autoimmune, hypercoagulable state caused by antiphospholipid antibodies.’
- “APS provokes blood clots (thrombosis) in both arteries and veins as well as pregnancy-related complications such as miscarriage, stillbirth, preterm delivery, and severe preeclampsia.”
- “In APS patients, the most common venous event is deep vein thrombosis of the lower extremities, and the most common arterial event is stroke.”
APS (associated with miscarriage, stillbirth. preterm delivery and stroke) is 3X more likely if low vitamin D – meta-analysis Oct 2017
- How a Stroke Turned a 63-Year-Old Into a Rap Legend Jam 2019
No mention of Vitamin D
physician blacking out from APS, changed career to Musician
Like many survivors of stroke, his speech became slurred and he sometimes stuttered. His personality also seemed to change. He suddenly became obsessed with reading and writing poetry. Soon, Hershfield’s friends noticed another unusual side effect: He couldn’t stop speaking in rhyme. He finished everyday sentences with rhyming couplets, like “Now I have to ride the bus, it’s enough to make me cuss.” And curiously, whenever he rhymed, his speech impediments disappeared.
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