title: Low vitamin D status in systemic sclerosis and the impact on disease phenotype.
abstract: OBJECTIVE
  Vitamin D has pleiotropic effects including immunomodulatory, cardioprotective, and antifibrotic properties and is thus able to modulate the three main links in scleroderma pathogenesis. The aim of the study was to evaluate the level of vitamin D in patients with systemic sclerosis and to analyze the associations between the concentration of vitamin D and the features of systemic sclerosis.
  
  
  METHODS
  Fifty-one consecutive patients were evaluated for visceral involvement, immunological profile, activity, severity scores, and quality of life. The vitamin D status was evaluated by measuring the 25hydroxy-hydroxyvitamin D serum levels.
  
  
  RESULTS
  The mean vitamin D level was 17.06±9.13 ng/dL. Only 9.8% of the patients had optimal vitamin D levels; 66.66% of them had insufficient 25(OH)D levels, while 23.52% had deficient levels. No correlation was found between vitamin D concentration and age, sex, autoantibody profile, extent of skin involvement, or vitamin D supplementation. Vitamin D levels were correlated with the diffusing capacity of the lung for carbon monoxide (p=0.019, r=0.353), diastolic dysfunction (p=0.033, r=-0.318), digital contractures (p=0.036, r=-0.298), and muscle weakness (p=0.015, r=-0.377) and had a trend for negative correlation with pulmonary hypertension (p=0.053, r=-0.29).
  
  
  CONCLUSIONS
  Low levels of vitamin D are very common in systemic sclerosis. Poor vitamin status seems to be related with a more aggressive disease with multivisceral and severe organ involvement, especially pulmonary and cardiac involvement.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Laura
authors.initials: L
authors.lastname: Groseanu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Violeta
authors.initials: V
authors.lastname: Bojinca
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Tania
authors.initials: T
authors.lastname: Gudu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Ioana
authors.initials: I
authors.lastname: Saulescu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Denisa
authors.initials: D
authors.lastname: Predeteanu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Andra
authors.initials: A
authors.lastname: Balanescu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Florian
authors.initials: F
authors.lastname: Berghea
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Opris
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Andreea
authors.initials: A
authors.lastname: Borangiu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Cosmin
authors.initials: C
authors.lastname: Constantinescu
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Magda
authors.initials: M
authors.lastname: Negru
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Internal Medicine, Division of Rheumatology, Sfanta Maria Clinical Hospital, Bucharest, Romania.
authors.forename: Ruxandra
authors.initials: R
authors.lastname: Ionescu
keywords: Systemic scleroderma; visceral involvement; vitamin D