Vitamin D status in ANCA-associated vasculitis

Irena Doubelt; David Cuthbertson; Simon Carette; Nader A Khalidi; Curry L Koening; Carol Langford; Carol A McAlear; Larry W Moreland; Paul Monach; Philip Seo; Ulrich Specks; Kenneth J Warrington; Peter A Merkel; Christian Pagnoux

doi:10.1093/rap/rkad021

Vitamin D status in ANCA-associated vasculitis

Rheumatol Adv Pract. 2023 Feb 10;7(1):rkad021. doi: 10.1093/rap/rkad021. eCollection 2023.

Authors

Affiliations

¹ Vasculitis Clinic, Mount Sinai Hospital, Department of Rheumatology, University of Toronto, Toronto, ON, Canada.
² Health Informatics Institute, University of South Florida, Tampa, FL, USA.
³ Division of Rheumatology, McMaster University and St. Joseph's Healthcare, Hamilton, ON, Canada.
⁴ Division of Rheumatology, University of Utah Hospital, Salt Lake City, UT, USA.
⁵ Division of Rheumatology, Cleveland Clinic, Cleveland, OH, USA.
⁶ Division of Rheumatology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁷ Division of Rheumatology, University of Pittsburgh, Pittsburgh, PA, USA.
⁸ Division of Rheumatology, VA Boston Healthcare System, Boston, MA, USA.
⁹ Division of Rheumatology, Johns Hopkins University, Baltimore, MD, USA.
¹⁰ Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
¹¹ Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.

Abstract

Objective: Vitamin D might participate in the pathogenesis of several immune-mediated diseases, but few related data are available for ANCA-associated vasculitis (AAV). In this study, we analysed the association between vitamin D status and disease in patients with AAV.

Methods: Serum levels of 25(OH)D_2/ ₃ were measured in 125 randomly selected patients with AAV [granulomatosis with polyangiitis (n = 50), eosinophilic granulomatosis with polyangiitis (n = 50) or microscopic polyangiitis (n = 25)] enrolled in the Vasculitis Clinical Research Consortium Longitudinal Studies at the time of enrolment and a subsequent relapse visit. Sufficient, insufficient and deficient vitamin D status were defined as 25(OH)D₃ levels >30, 20-30 and ˂20 ng/ml, respectively.

Results: Seventy of 125 patients (56%) were female, with a mean age of 51.5 (16) years at diagnosis; 84 (67%) were ANCA positive. Mean 25(OH)D was 37.6 (16) ng/ml, with vitamin D deficiency in 13 (10.4%) and insufficiency in 26 (20.8%). In univariate analysis, lower vitamin D status was associated with male sex (P = 0.027) and disease activity (P = 0.047). In univariate and multivariate analyses, deficient vitamin D status was associated with disease activity (P = 0.015). Mean 25(OH)D status in the 21 patients with a subsequent relapse did not differ between baseline and relapse visit [37.8 (16) vs 38.0 (10) ng/ml, respectively; P = 0.92].

Conclusion: Most patients with AAV have sufficient 25(OH)D levels, although those with lower vitamin D status were more likely to be male and to have active disease. Whether optimization of vitamin D status alters disease manifestations or activity in AAV remains to be determined.

Trial registration: Vasculitis Clinical Research Consortium (VCRC) Longitudinal Study (LS), NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380.

Keywords: ANCA-associated vasculitis; cohort study; eosinophilic granulomatosis with polyangiitis; granulomatosis with polyangiitis; microscopic polyangiitis; vitamin D.

Associated data

ClinicalTrials.gov/NCT00315380