Date: Monday, November 9, 2015
Session Type: ACR Concurrent Abstract Session
Session Time: 2:30PM-4:00PM
Background/Purpose: Vitamin D has an important effect in bone quality and vitamin D deficiency in Juvenile-onset Systemic Lupus Erythematosus patients (JoSLE) may be associated with lower spine and whole body bone mineral density. Besides, vitamin D has an important immunomodulatory effect that justified its use in autoimmune disease including JoSLE. However, there are no trials that directly addressed the boosting of serum levels of 25-hydroxyvitamin D (25OHD) in bone microarchitecture in JoSLE. The aim of this study was to evaluate the effect of vitamin D supplementation on bone microarchitecture parameters in JoSLE.
Methods: This study was a randomized double-blind placebo-controlled 24-week trial conducted in the Rheumatology Outpatient Clinic, University of Sao Paulo. Forty JoSLE patients (according to ACR classification criteria) up to 25 years old were randomized (1:1) to receive oral cholecalciferol 50,000 IU/week (JoSLE-VitD)(n=22) or placebo (JoSLE-PL)(n=23). Before randomization a three months washout of vitamin D was performed for all patients. Medications remained stable throughout the study. Serum levels of 25OHD were measured using radioimmunoassay. Disease activity was assessed by the SLE Disease Activity Index (SLEDAI). Bone microarchitecture and volumetric bone density were analysed at baseline and after 24 weeks by HR-pQCT (High-resolution peripheral quantitative computed tomography) at tibia site.
Results: At baseline, groups were similar regarding, age, body mass index, organ involvement, glucocorticoid dose, use of immunosuppressive drugs, parameters of bone microarchitecture and volumetric density, SLEDAI and levels of 25OHD. The mean 25OHD serum levels at baseline were similar in JoSLE-VitD and JoSLE-PL groups (19.1 vs. 19.5 ng/ml, p=0.82), as well the mean serum levels of total calcium [9.4 (0.5) vs. 9.1 (0.5) mg/dl, p=0.11]. After 24 weeks, the mean level of 25OHD was higher in the JoSLE-VitD group [31.3 (8.6) vs. 16.5 (5.8) ng/ml, p<0.001] and also a higher decrease was observed in SLEDAI score in JoSLE-VitD [D(final – baseline) SLEDAI: -0.58 ± 2.39 vs. 1.25 ± 3.76, p=0.01)] compared to JoSLE-PL. No difference was observed regarding an improvement of any clinical parameter.
Concerning bone microarchiteture, an increase in trabecular number [DTb.N: 0.162 (0.24) vs. 0.028 (0.19) mm, p=0.024] and a decreased in trabecular separation [DTb.Sp: -0.045 (0.06) vs. 0.001 (0.04) mm, p=0.017] were observed in the JoSLE-VitD group compared to JoSLE-PL at tibia site. No differences were observed in other structural parameters [trabecular (Tb.Th) and cortical thickness (Ct.Th)] and volumetric bone mineral densities [trabecular (Tb.BMD) and cortical (Ct.BMD)] (p>0.05).
Conclusion: This study suggests that cholecalciferol supplementation for 24 weeks is effective in improving bone microarchitecture parameters in JoSLE patients. Therefore, a therapeutic intervention may be recommended for patients with 25OHD deficiency. (Clinical Trial Registry: NCT01892748).
To cite this abstract in AMA style:Lima G, Paupitz J, Aikawa NE, Alvarenga JC, Bonfá E, Pereira RMR. A Randomised Double-Blind Placebo-Controlled Trial of Vitamin D Supplementation in Juvenile-Onset Systemic Lupus Erythematosus: Effects on Microarchitecture Measured By HR-pQCT [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). http://acrabstracts.org/abstract/a-randomised-double-blind-placebo-controlled-trial-of-vitamin-d-supplementation-in-juvenile-onset-systemic-lupus-erythematosus-effects-on-microarchitecture-measured-by-hr-pqct/. Accessed January 22, 2018.
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