title: Vitamin D in systemic lupus erythematosus: modest association with disease activity and the urine protein-to-creatinine ratio.
abstract: OBJECTIVE
  To investigate whether an increase in vitamin D levels in patients with systemic lupus erythematosus (SLE) was associated with improvement in disease activity.
  
  
  METHODS
  A total of 1,006 SLE patients were monitored over 128 weeks. SLE patients with low levels of 25-hydroxyvitamin D (25[OH]D; <40 ng/ml) were given supplements of 50,000 units of vitamin D2 weekly plus 200 units of calcium/vitamin D3 twice daily. Longitudinal regression models were used to estimate the association between levels of 25(OH)D and various measures of disease activity.
  
  
  RESULTS
  The SLE patients had the following characteristics: 91% were female, their mean age was 49.6 years, and their ethnicity was 54% Caucasian, 37% African American, and 8% other. For those with levels of 25(OH)D <40 ng/ml, a 20-unit increase in the 25(OH)D level was associated with a mean decrease of 0.22 (95% confidence interval [95% CI] -0.41, -0.02) (P = 0.032) in the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). This corresponded to a 21% decrease in the odds of having a SELENA-SLEDAI ≥5 (95% CI 1, 37). The mean urine protein-to-creatinine ratio decreased by 2% (95% CI -0.03, -0.01) (P = 0.0001), corresponding to a 15% decrease in the odds of having a ratio >0.5 (95% CI 2, 27).
  
  
  CONCLUSIONS
  We found that a 20-ng/ml increase in the 25(OH)D level was associated with a 21% decrease in the odds of having a high disease activity score and a 15% decrease in the odds of having clinically important proteinuria. Although these associations were statistically significant, the clinical importance is relatively modest. There was no evidence of additional benefit of 25(OH)D beyond a level of 40 ng/ml.
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, MD, USA. mpetri@jhmi.edu
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.forename: Kayode J
authors.initials: KJ
authors.lastname: Bello
authors.forename: Hong
authors.initials: H
authors.lastname: Fang
authors.forename: Laurence S
authors.initials: LS
authors.lastname: Magder
mesh_terms: D000328:Adult; D002118:Calcium / Q000627:therapeutic use; D002762:Cholecalciferol / Q000627:therapeutic use*; D015331:Cohort Studies; D003404:Creatinine / Q000652:urine; D004872:Ergocalciferols / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications / Q000188:drug therapy*
chemical_list: D004872:Ergocalciferols; D014807:Vitamin D; D002762:Cholecalciferol; C104450:25-hydroxyvitamin D; D003404:Creatinine; D002118:Calcium
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