Vitamin D receptor expression level in patients with SLE and its relationship with vitamin D status, disease course and bone mineral density

Abstract

Objective To determine vitamin D receptor (VDR) blood serum concentrations in patients with SLE and to assess the relationship with vitamin D status, disease course, bone turnover markers levels and bone mineral density (BMD).

Methods The cross-sectional study involved 99 patients with SLE and 30 controls. We assessed VDR, vitamin D, C-reactive protein (CRP), interleukin (IL) 6, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX) concentrations, and erythrocyte sedimentation rate (ESR) in study subjects. Dual-energy X-ray absorptiometry was also performed.

Results Mean VDR levels in patients with SLE and in the control group were 12.78±0.61 ng/mL and 23.12±0.61 ng/mL, accordingly (p<0.01). 77.8% patients with SLE had low VDR concentrations and only 22.2% patients presented relatively normal or high levels. Low VDR levels in patients with SLE were associated with age (p=0.054, r=−0.22). The study did not reveal a relationship between VDR level and sex, disease duration, body mass index (BMI) and cumulative glucocorticoid (GC) dose. No association was found between VDR level and a diagnosed lupus nephritis, creatinine concentration and glomerular filtration rate. The correlation analysis confirmed the association of low VDR level with high disease activity, namely with elevated CRP (r=−0.22), IL-6 (r=−0.21) levels, SLE Disease Activity Index 2000 variant (r=−0.20). VDR concentration was closely associated with vitamin D supply. The average level of vitamin D in patients with low VDR was 33.55% lower than in the group with a relatively normal vitamin concentration (p=0.0001, r=0.47). We revealed a proportional increase of CTX concentration associated with VDR decrease (p<0.05, r=−0.27). No significant difference in average Z-score, T-score and BMD between the groups of patients with SLE with low and relatively normal VDR levels (p>0.05) was found.

Conclusion Low VDR concentration is a common phenomenon in patients with SLE associated with age, high disease activity, vitamin D supply and serum CTX concentration. VDR concentration had no significant association with sex, disease duration, cumulative GC dose, BMI, a diagnosed lupus nephritis, Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, OC level and BMD.