The Benefit of Vitamin D on SLE Disease Activity Is Largely Explained By Renal Activity

Michelle Petri¹, Daniel Goldman² and Laurence S Magder³, ¹Medicine (Rheumatology), Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA, Baltimore, MD, ²Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, ³Epidemiology and Public health, University of Maryland School of Medicine, Baltimore, MD

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: renal disease and systemic lupus erythematosus (SLE), Vitamin D

Session Information

Date: Tuesday, November 7, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment Poster III: Therapeutics and Clinical Trial Design

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Low vitamin D is commonly found in SLE. In previous studies, supplementation of vitamin D resulted in improvement in the Physician Global Assessment and SLEDAI. We now present the first analysis of the relationship between vitamin D and individual organ activity, based on a large clinical cohort.

Methods: This analysis is based on cohort visits where vitamin D was measured starting in 2010. There were 16,519 visits from 1,345 different patients (92% female, 50% Caucasian, 41% African American). If the patient received any score for an organ system component on the SELENA-SLEDAI, then the patient was defined as having that type of activity.

Results: The following activities were observed (percentage of visits): immunologic (33%), cutaneous (32%), renal (7%), musculoskeletal (5%), hematologic (5%), serologic (2%), vasculitic (1%), CNS (<1%), and constitutional (<1%). The association between levels of Vitamin D and disease activity in the top three organs is shown in Table 1.

Table 1. Estimated association between vitamin D levels and odds of organ-specific lupus disease activity, adjusting for age, race, sex, calendar year, prednisone use and plaquenil use.

Vitamin D Level (ng/mL)	Cutaneous Activity		Renal Activity		Musculoskeletal Activity
Vitamin D Level (ng/mL)	OR (95% CI)	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
<10 (n=163)	1.4 (1.0, 2.1)	0.049	3.1 (2.0, 4.9)	<0.0001	1.3 (0.7, 2.6)	0.39
10 – <20 (n=1039)	0.9 (0.8, 1.1)	0.41	2.2 (1.5, 3.1)	<0.0001	1.1 (0.8, 1.6)	0.61
20 – <30 (n=2760)	1.0 (0.9, 1.2)	0.53	1.6 (1.2, 2.0)	0.0008	1.0 (0.7, 1.3)	0.93
30 – <40 (n=3959)	1.1 (1.0, 1.2)	0.13	1.2 (0.9, 1.5)	0.23	0.9 (0.7, 1.2)	0.43
40 – <50 (n=3578)	1.0 (Ref Grp)		1.0 (Ref Grp)		1.0 (Ref Grp)
50 – <60 (n=2308)	1.1 (0.9, 1.3)	0.19	1.0 (0.7, 1.3)	0.91	1.2 (0.9, 1.5)	0.23
60 – <70 (n=929)	1.0 (0.8, 1.3)	0.74	0.8 (0.5, 1.3)	0.33	1.2 (0.9, 1.7 )	0.19
70 – <80 (n=504)	1.3 (1.0, 1.7)	0.072	0.8 (0.4, 1.4)	0.41	0.7 (0.4, 1.2)	0.19
80+ (n=356)	1.4 (1.0, 1.9)	0.072	0.6 (0.3, 1.6)	0.32	1.3 (0.8, 2.1)	0.36

For cutaneous activity, there was a significantly elevated risk among those in the very extreme low level of vitamin D. For Renal Activity, vitamin D > 40 ng/mL lowered the risk of renal disease activity. For musculoskeletal activity, there was no association with vitamin D levels.

We then conducted a “within person” analysis between vitamin D and renal disease activity. In this analysis, each person serves as her own control, and the question is: “When a person has a vitamin D level lower than his/her average, are they more likely to have renal disease activity”. This analysis implicitly adjusts for race, sex, and all variables (measured and unmeasured) that are invariant within a person. The results are shown in Table 2.

Table 2. Within-person analysis of the relationship between vitamin D levels and renal activity adjusting for prednisone use, plaquenil use, and implicitly for all time-invariant characteristics.

Vitamin D Level	Renal Activity Odds Ratio	P-value
10 ng/mL or more lower than personal average	1.5 (1.3, 1.8)	<0.0001
Within 10 ng/mL of the personal average	1.0 (Ref Grp)
10 ng/mL or more higher than personal average	0.8 (0.7, 1.0)	0.080

There was a relationship between vitamin D and all three components of SELENA-SLEDAI Renal Activity: hematuria, proteinuria, or pyuria.

Conclusion: Low vitamin D was associated with mucocutaneous activity only at extremely low vitamin D levels. The major association was with renal activity. This association held true in “within person” analysis and held true for proteinuria, hematuria and pyuria, as well. Given the safety of vitamin D supplementation, this immunomodulator should now be considered standard of care for lupus nephritis.

Disclosure: M. Petri, Anthera Inc, 5,GlaxoSmithKline, 5,EMD Serono, 5,Eli Lilly and Company, 5,Bristol Meyer Squibb, 5,Amgen, 5,United Rheumatology, 5,Global Academy, 5,Exagen, 2; D. Goldman, None; L. S. Magder, None.

To cite this abstract in AMA style:

Petri M, Goldman D, Magder LS. The Benefit of Vitamin D on SLE Disease Activity Is Largely Explained By Renal Activity [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/the-benefit-of-vitamin-d-on-sle-disease-activity-is-largely-explained-by-renal-activity/. Accessed .

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