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Abstract Number: 2958

Vitamin D, Cognition and Cerebral Structural Abnormalities in Childhood- Onset Systemic Lupus Erythematosus

Nailu A. Sinicato1, Mariana Postal2, Aline Tamires Lapa2, Bruna B Siqueira3, Karina Pelicari2, Paula T Fernades3, Roberto Marini Sr.4 and Simone Appenzeller5, 1Pediatrics, State University of Campinas, Campinas, Brazil, 2Medicine, State University of Campinas, Campinas, Brazil, 3State University of Campinas, Campinas, Brazil, 4Pediatric Rheumatology Unit, State University of Campinas, São Paulo, Brazil, 5Division of Rheumatology, Faculty of Medical Science, State University of Campinas, São Paulo, Brazil

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Cognitive dysfunction, magnetic resonance imaging (MRI) and systemic lupus erythematosus (SLE), Vitamin D

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Session Information

Date: Tuesday, November 10, 2015

Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session III

Session Type: ACR Poster Session C

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

Background/Purpose: About 16-95% of SLE patients have vitamin D insufficiency. Vitamin D levels, especially vitamin D deficiency, are associated with cognitive performance in adults. We aimed to analyze the association of vitamin D levels, cognitive impairment and cerebral structures in childhood-onset Systemic Lupus Erythematosus (cSLE).

Methods: We screened consecutive cSLE patients, disease-onset before the age of 18 years followed in the pediatric rheumatology unit at the State University of Campinas.  Controls were matched for age, sex and demographic background. Levels of 25-hydroxyvitamin D3 were measured in serum samples, using a commercial enzyme-linked immunosorbent assay; vitamin D levels were considered deficient (<10pg/mL), insufficient (10-29pg/mL), sufficient (30-100pg/mL) and toxic (>100pg/mL). cSLE patients were assessed for disease activity by Systemic Lupus Erythematosus disease activity index (SLEDAI) and damage [Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI)]. Cognitive evaluation was performed in all participants using Wechsler Intelligence Scale, according to age and validated in Portuguese. Cognitive dysfunction was defined when scores were ≤-2 standard deviations (SD) from controls in 1 or more subtests. Magnetic resonance imaging scans were performed using a standardized protocol and volumetric 1mm T1 weighted images were used for analysis. Volumes ≤ 2 SD from the means of controls were considered abnormal. White matter (WM) lesions were analyzed in T2-weighted images using a semiautomatic computer program (Neuroline®). Non-parametric tests were used for statistical analysis.

Results:

We included 100 cSLE patients (mean age 16.8 years (SD±4.4) and 37 controls (mean age 18.7 years (SD±4.8). The mean vitamin D level was 32.4±18.7pg/ml in cSLE and 36.5±19.8pg/ml in controls (p=0.22). Cognitive impairment was observed in 27 (47%) cSLE patients and 6 (25%) controls (p=0.001). No association between vitamin D levels and cognitive impairment (p=0.219), SLEDAI (p=0.469), SDI (p=0.915) and corticosteroid use (p=0.486) was observed.

Forty-seven (47%) cSLE patients and 13 (35%) controls had vitamin D insufficiency (p=0.08). Vitamin D insufficiency was not associated with cognitive impairment (p=0.24). When analyzing individual cognitive tests, we observed that vitamin D levels were associated with forward digits span (p=0.04) and correlated indirectly with cubes (r=-0.265;p=0.05) in cSLE patients. No association with structural abnormalities [hippocampal (p=0.466), cerebral (p=0.610) and cerebellum (p=0.475) atrophy] and WM lesion (p=0.601) was observed.

Conclusion: Vitamin D insufficiency was frequent in both cSLE and controls. Although vitamin D levels were not associated with cognitive impairment and cerebral structural abnormalities, we observed an association of vitamin D insufficiency and cognitive subtests associated with retention of immediate memory, analytical skills, visual-motor-spatial coordination, perceptual speed and organization in cSLE patients. Therefore vitamin D levels may contribute to cognitive dysfunction in cSLE and should be followed closely and corrected when indicated.


Disclosure: N. A. Sinicato, None; M. Postal, None; A. T. Lapa, None; B. B Siqueira, None; K. Pelicari, None; P. T Fernades, None; R. Marini Sr., None; S. Appenzeller, None.

To cite this abstract in AMA style:

Sinicato NA, Postal M, Lapa AT, B Siqueira B, Pelicari K, T Fernades P, Marini R Sr., Appenzeller S. Vitamin D, Cognition and Cerebral Structural Abnormalities in Childhood- Onset Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/vitamin-d-cognition-and-cerebral-structural-abnormalities-in-childhood-onset-systemic-lupus-erythematosus/. Accessed .
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