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AB0409 An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity
  1. L. C. Breslin1,
  2. E. Ball2,
  3. D. Armstrong3,
  4. A. Bell2,
  5. P. Magee1,
  6. E. Laird1,
  7. J. Wallace1,
  8. E. McSorley1
  1. 1Northern Ireland Centre for Food and Health, University of Ulster, Derry
  2. 2Rheumatology Unit, Musgrave Park Hospital, Belfast
  3. 3Rheumatology Department, Altnagelvin Ara Hospital, Derry, United Kingdom

Abstract

Background Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease in which fatigue and impaired quality of life (QoL) commonly manifest. Fatigue has been associated with increased disease activity in SLE1-3 and both fatigue and disease activity are considered predictors of impaired QoL2-4, although some studies have not reported any association between disease activity and QoL5-6.

Objectives The aim of this study was twofold, firstly to determine whether vitamin D is associated with fatigue and QoL in SLE patients during the winter when status would be expected to be lowest and again during summer when vitamin D levels are thought to be highest and secondly to examine for any relationship between fatigue, QoL and disease activity.

Methods SLE patients were recruited from November to March (winter) (n=52) and followed up during June and July (summer) (n=50). Serum 25-hydroxyvitamin D (25(OH)D) was measured by liquid chromatography mass spectrometry. Fatigue was assessed using the fatigue severity score (FSS) and QoL was examined using the 36-item short form questionnaire (SF-36). Disease activity and damage were scored using versions of Systemic Lupus Activity Measure, Systemic Lupus Erythematosus Disease Activity Index, British Isles Lupus Assessment Group and Systemic Lupus International Collaborative Clinics/American College of Rheumatology. Primary statistical analysis included Spearman’s rho correlation and two tailed paired t-test. Multivariate and logistic regression analysis was employed to investigate potential predictors of fatigue and QoL. To investigate whether vitamin D was associated with fatigue and QoL, data from the serial winter and summer measurements were combined to give a larger sample (n=102) with greater power and regression analysis was reapplied.

Results During the winter and summer months respectively 47 (96%) and 49 (98%) SLE patients reported fatigue (FSS ≥ 3) and 98% of the cohort presented with vitamin D inadequacy (25(OH)D < 75 nmol/L) throughout the year. The mental component score (MCS) (95% CI 0.02, 5.42, P=0.049) and social functioning (SF) (95% CI 1.01, 13.27 P=0.023) subscales of the SF-36 were reduced during the summer. Analysis from the serial winter and summer data, reported vitamin D status to be reduced in those with fatigue (n=96) (95% CI -39.46, -2.03, P=0.030) and FSS and SF-36 significantly correlated with all disease activity measures.

Conclusions Vitamin D inadequacy, fatigue and poor QoL were prevalent in this cohort of Northern Irish SLE patients. Given the observation of reduced vitamin D in those with fatigue and the association between vitamin D and disease activity, it is plausible that improvements in fatigue mediated via increasing 25(OH)D may indirectly improve disease activity and possibly enhance QoL. Further research such as placebo controlled vitamin D intervention trials are warranted to investigate this hypothesis before any firm conclusions can be made.

  1. Zonana-Nacach et al. Lupus 2000; 9(2):101-9.

  2. Kozora E et al. Arthritis Rheum 2006; 55(4):628-35.

  3. Mattsson et al. Scand J Rheumatol 2008; 37(4):269-77.

  4. Jolly & Utset. Lupus 2004; 13(12):924-6.

  5. Moldovan et al. Lupus 2011; 20(12):1285-92.

  6. Leong et al. Lupus 2010; 19(1):100-6.

References

Disclosure of Interest None Declared

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