title: Elevated 1, 25-dihydroxyvitamin D levels are associated with protracted treatment in sarcoidosis.
abstract: BACKGROUND
  Active vitamin D metabolite, 1, 25-dihydroxyvitamin D, has pleomorphic effects on both innate and acquired immunity. Sarcoid granuloma derived 1, 25-dihydroxyvitamin D leads to hypercalcemia, but the association of 1, 25-dihydroxyvitamin D with the clinical phenotype of the disease is currently unknown.
  
  
  OBJECTIVE
  To determine the relationship between serum 1, 25-dihydroxyvitamin D levels and the degree of sarcoidosis disease chronicity.
  
  
  METHODS
  Serum 1, 25-dihydroxyvitamin D levels were measured and associated with sarcoidosis activity and phenotypes as assessed by Sarcoidosis Severity Score and Sarcoidosis Clinical Activity Classification respectively.
  
  
  RESULTS
  Fifty nine patients were recruited with 44% having a sub-acute onset, and the chronic disease phenotype. There was no significant difference in serum 1, 25-dihydroxyvitamin D levels by chest radiograph stage (p = 0.092) nor did the levels correlate with the Sarcoidosis Severity Score (r = -0.16; p = 0.216). Serum 1, 25-dihydroxyvitamin D levels were associated with patients requiring repeated regimens of systemic immunosuppressive therapy or >1 year of therapy (SCAC Class 6). Increasing quartiles of serum 1, 25-dihydroxyvitamin D level was associated increased odds of the chronic phenotype (OR 1.82, 95% CI, 1.11, 2.99, p = 0.019). The majority (71%) of the patients with levels >51 pg/mL required chronic immunosuppressive therapy as defined by SCAC class 6.
  
  
  CONCLUSIONS
  In patients with sarcoidosis, elevated 1, 25-dihydroxyvitamin D levels are associated with chronic treatment needs.
authors.affiliation: Henry Ford Hospital, Division of Pulmonary and Critical Care Medicine, Detroit, MI 48202, USA.
authors.forename: Dashant
authors.initials: D
authors.lastname: Kavathia
authors.forename: John D
authors.initials: JD
authors.lastname: Buckley
authors.forename: Dhanwada
authors.initials: D
authors.lastname: Rao
authors.forename: Benjamin
authors.initials: B
authors.lastname: Rybicki
authors.forename: Robert
authors.initials: R
authors.lastname: Burke
mesh_terms: D001741:Black or African American; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004100:Dihydroxycholecalciferols / Q000097:blood*; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011859:Radiography; D012507:Sarcoidosis / Q000097:blood* / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D044465:White People
chemical_list: D015415:Biomarkers; D004100:Dihydroxycholecalciferols