An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity

Leanne Breslin, Elisabeth Ball, David Armstrong, Aubrey Bell, Pamela Magee, Eamon Laird, Julie Wallace, Emeir McSorley

Research output: Contribution to journalArticle

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.Zonana-Nacach et al. Lupus 2000; 9(2):101-9.Kozora E et al. Arthritis Rheum 2006; 55(4):628-35.Mattsson et al. Scand J Rheumatol 2008; 37(4):269-77.Jolly & Utset. Lupus 2004; 13(12):924-6.Moldovan et al. Lupus 2011; 20(12):1285-92.Leong et al. Lupus 2010; 19(1):100-6.
LanguageEnglish
Pages912
JournalAnnals of the Rheumatic Diseases
Volume72
Issue numberSuppl
DOIs
Publication statusPublished - 2013

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Vitamins
Systemic Lupus Erythematosus
Observational Studies
Fatigue
Quality of Life
Fatigue of materials
Vitamin D
Regression analysis
Regression Analysis
Rheum
Liquid chromatography
Liquid Chromatography
Autoimmune Diseases
Arthritis
Mass spectrometry
Logistics
Mass Spectrometry
Statistical methods

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@article{9534008a55a841a0a74f473d4e743889,
title = "An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity",
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.Zonana-Nacach et al. Lupus 2000; 9(2):101-9.Kozora E et al. Arthritis Rheum 2006; 55(4):628-35.Mattsson et al. Scand J Rheumatol 2008; 37(4):269-77.Jolly & Utset. Lupus 2004; 13(12):924-6.Moldovan et al. Lupus 2011; 20(12):1285-92.Leong et al. Lupus 2010; 19(1):100-6.",
author = "Leanne Breslin and Elisabeth Ball and David Armstrong and Aubrey Bell and Pamela Magee and Eamon Laird and Julie Wallace and Emeir McSorley",
year = "2013",
doi = "10.1136/annrheumdis-2013-eular.2731",
language = "English",
volume = "72",
pages = "912",
journal = "Annals of the Rheumatic Diseases",
issn = "0003-4967",
number = "Suppl",

}

An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity. / Breslin, Leanne; Ball, Elisabeth; Armstrong, David; Bell, Aubrey; Magee, Pamela; Laird, Eamon; Wallace, Julie; McSorley, Emeir.

In: Annals of the Rheumatic Diseases, Vol. 72, No. Suppl, 2013, p. 912.

Research output: Contribution to journalArticle

TY - JOUR

T1 - An observational study of vitamin d in systemic lupus erythematosus patients: associations among vitamin d status, fatigue, quality of life and disease activity

AU - Breslin, Leanne

AU - Ball, Elisabeth

AU - Armstrong, David

AU - Bell, Aubrey

AU - Magee, Pamela

AU - Laird, Eamon

AU - Wallace, Julie

AU - McSorley, Emeir

PY - 2013

Y1 - 2013

N2 - 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.Zonana-Nacach et al. Lupus 2000; 9(2):101-9.Kozora E et al. Arthritis Rheum 2006; 55(4):628-35.Mattsson et al. Scand J Rheumatol 2008; 37(4):269-77.Jolly & Utset. Lupus 2004; 13(12):924-6.Moldovan et al. Lupus 2011; 20(12):1285-92.Leong et al. Lupus 2010; 19(1):100-6.

AB - 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.Zonana-Nacach et al. Lupus 2000; 9(2):101-9.Kozora E et al. Arthritis Rheum 2006; 55(4):628-35.Mattsson et al. Scand J Rheumatol 2008; 37(4):269-77.Jolly & Utset. Lupus 2004; 13(12):924-6.Moldovan et al. Lupus 2011; 20(12):1285-92.Leong et al. Lupus 2010; 19(1):100-6.

U2 - 10.1136/annrheumdis-2013-eular.2731

DO - 10.1136/annrheumdis-2013-eular.2731

M3 - Article

VL - 72

SP - 912

JO - Annals of the Rheumatic Diseases

T2 - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - Suppl

ER -