REVIEW ARTICLE


To Supplement or not to Supplement? The Rationale of Vitamin D Supplementation in Systemic Lupus Erythematosus



Alessandra Nerviani1, 2, *, Daniele Mauro1, Michele Gilio3, Rosa Daniela Grembiale4, Myles J. Lewis1
1 Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
2 IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
3 Internal Medicine - Emergency Department San Carlo Hospital, Department of Health Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
4 Department of Health Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy


© 2018 Nerviani et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Experimental Medicine and Rheumatology, William Harvey Research Institute and Barts and The London, School of Medicine and Dentistry Queen Mary University of London, London, UK; Tel: +44 020 7882 8195; E-mail: a.nerviani@qmul.ac.uk


Abstract

Background:

Systemic Lupus Erythematosus (SLE) is a systemic autoimmune disease characterised by abnormal activation of the immune system, chronic inflammation and organ damage. Lupus patients are more prone to be vitamin D deficient. However, current evidence is not conclusive with regards to the role played by vitamin D in SLE development, progression, and clinical manifestations.

Objective:

Here, we will summarise the current knowledge about vitamin D deficiency prevalence, risk factors, molecular effects, and potential pathogenic role in SLE. We will focus on the link between vitamin D deficiency and lupus clinical manifestations, and on the clinical trials assessing the effects of vitamin D supplementation in SLE.

Method:

A detailed literature search was performed exploiting the available databases, using “vitamin D and lupus/SLE” as keywords. The relevant interventional trials published over the last decade have been considered and the results are reported here.

Conclusion:

Several immune cells express vitamin D receptors. Thus, an immunomodulatory role for vitamin D in lupus is plausible. Numerous observational studies have investigated the relationship between vitamin D levels and clinical/serological manifestations of SLE with contrasting results. Negative correlations between vitamin D levels and disease activity, fatigue, renal and cardiovascular disease, and anti-dsDNA titres have been described but not conclusively accepted. In experimental models of lupus, vitamin D supplementation can improve the disease. Interventional trials have assessed the potential therapeutic value of vitamin D in SLE, but further larger studies are needed.

Keywords: Vitamin D, Lupus, Supplementation, Disease Activity, Immune System, Erythematosus.