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Open Access Highly Accessed Research article

Vitamin D levels in Indian systemic lupus erythematosus patients: association with disease activity index and interferon alpha

Manamita Mandal1, Rina Tripathy2, Aditya K Panda3, Sarit S Pattanaik1, Simanchal Dakua1, Anjan Kumar Pradhan4, Soumen Chakraborty4, Balachandran Ravindran3* and Bidyut K Das1*

Author Affiliations

1 Department of Medicine, SCB Medical College, Medical College Road, Cuttack, OD 753007, India

2 Department of Biochemistry, SCB Medical College, Medical College Road, Cuttack, OD 753007, India

3 Infectious Disease Biology Group, Institute of Life Sciences, Nalco Nagar Road, Bhubaneswar, OD 751023, India

4 Department of Gene Function and Regulation, Institute of Life Sciences, Nalco Nagar Road, Bhubaneswar, OD 751023, India

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Arthritis Research & Therapy 2014, 16:R49  doi:10.1186/ar4479

Published: 10 February 2014

Abstract

Introduction

Low levels of vitamin D have been associated with several autoimmune disorders including multiple sclerosis, rheumatoid arthritis, type 1 diabetes and systemic lupus erythematosus (SLE). The major source of vitamin D is sunlight but exposure of SLE patients to UV rays has been shown to exacerbate disease pathology. Studies in various populations have shown an association between low vitamin D levels and higher SLE disease activity.

Methods

We enrolled 129 patients who fulfilled American College of Rheumatology criteria in the study. There were 79 treatment-naïve cases and 50 patients who were under treatment for underlying SLE. There were 100 healthy subjects from similar geographical areas included as controls. Plasma 25-OH vitamin D3 and interferon (IFN)-α levels were quantified by enzyme-linked immunosorbent assay (ELISA). The gene expression level of IFN-α was determined by quantitative real-time reverse transcriptase polymerase chain reaction (RT-PCR).

Results

Plasma 25-OH vitamin D3 significantly correlated in an inverse manner with systemic lupus erythematosus disease activity index (SLEDAI) scores (P <0.0001, r = -0.42), anti-dsDNA (P <0.0001, r = -0.39), plasma IFN-α (P <0.0001, r = -0.43) and levels of IFN-α gene expression (P = 0.0009, r = -0.45). Further, plasma levels of IFN-α positively correlated with gene expression of IFN-α (P <0.0001, r = 0.84). Treatment-naïve SLE patients displayed significantly higher plasma levels of IFN-α compared to patients under treatment (P <0.001) and controls (P <0.001).

Conclusions

These results suggest an important role of vitamin D in regulating disease activity in SLE patients and the need to supplement vitamin D in their treatment.