Background Primary Sjögren’s syndrome (pSjS) is a chronic autoimmune disease primarily involving the exocrine glands. The clinical picture of pSjS ranges from exocrinopathy to systemic disease. Environmental and hormonal factors, such as vitamin-D may play a role in the pathogenic process and disease expression and activity. The literature investigating the relationship between pSjS and vitamin D is limited.
Objectives We aimed to evaluate the levels of vitamin-D and its association with disease activity in pSjS.
Methods This study included 100 cases (M/F:3/97, mean age:47.33 ± 5.13/54.37± 9.56 years) with PSjS followed up by Ege University Department of Rheumatology. All the patients fulfilled the US-European Consensus Criteria. ESSDAI was used to assess the activation of Sjogren’s disease (EULAR “European League Against Rheumatism” Sjogren’s Syndrome Disease Activity Index).
Results In this study, 100 patients’ with pSjS the average vitamin D level was 48.17 ± 29.84 nmol / L, respectively. The average level of vitamin D of all patients’ was considered to be the lower limit of of 50 nm / L. In patients with pSjS anti-Ro was 59%, anti-La was 37%, ANA was 78% and RF was 49% positive.12% decrease in C3 and C4, globulin abnormalities in 30% (high-low) was observed. The parameters were investigated according to ESSDAI. Significant relationship were found between the anti-La positivity (p<0.05) and low levels of C4 (p<0.05). Significant relationship was not found between the articular involvement (73%)(p = 0.4), constitutional state (19%) (p = 0.514), glandular involvement (14%) (p = 0.182), and the vitamin D levels. In addition, no significant relationship was found between the level of vitamin D and the patient’s age and disease duration (p = 0.86, 0715). Patients were evaluated according to the SSDAIscoring activation, 12 patients were scoring ≥ 5 points. However, in these patients with active disease was not significantly correlated with vitamin D levels (p=0.51). According to the ESSDAI index the patients with involvement or without involvement have numerical difference between the vitamin D levels. However, there was no statistically significant difference.
Conclusions Significantrelationship were found between the anti-La positivity and low levels of C4. Other clinical and serological manifestations did not correlate with vitamin D status. In this study all the patients with pSjS are homogenous and monitored regularly in out patient rheumatology clinic. They have stable general condition and very low hospitalization rates. This result was thought to be taken for the low number of patients with a high involvement activity. However, further studies including more pSjS patients, as well as both healthy and disease control groups, are required to confirm the association of vitamin D levels and activity of pSjS.
Seror R, R Philippe, Bowman SJ et al. EULAR Sjögren’s syndrome disease activity index: development of a consensus systemic disease activity index for primary Sjögren’s syndrome. Ann Rheum Dis 2010;69:1103-1109
Vitali C, Palombi G, Baldini C, et al. Sjogren’s Syndrome Disease Damage Indexand Disease Activity Index Scoring Systems for the Assessment of Disease Damage and Disease Activity in Sjo¨gren’s Syndrome, Derived From an Analysis of a Cohort of Italian Patients. Arthritis and rheumatism. Vol. 56, No. 7, July 2007, pp 2223–2231.
Disclosure of Interest None Declared