Vitamin D deficiency and associated clinical co-factors in patients with early and late-onset plaque psoriasis
DOI:
https://doi.org/10.66344/jpad.v31i4.1663Keywords:
Psoriasis, body mass index, psoriatic arthritis, 25-hydroxy vitamin D, Psoriasis Area and Severity IndexAbstract
Objective To investigate 25-hydroxyvitamin D (25-OHVD) levels; to perform a comparative analysis between early and late-onset types of plaque psoriasis; and to identify any relationship between 25-OHVD levels and type of plaque psoriasis after controlling for confounders .
Methods This cross-sectional, prospective study had 70 subjects and was conducted in the Dermatology department during September 2018 to August 2019. Demographics and disease-related features were noted down; body mass index (BMI) and Psoriasis Area and Severity Index (PASI) were calculated; and serum levels of 25-OHVD were checked.
Results Mean±SD age was 41.3±13.2 years with equal gender ratio. Family history was positive in 19 (27.1%); presence of psoriatic arthritis (PsA) in 36 (51.4%); use of oral steroids in 14 (20%); while 40 (57.1%) patients had disease for ≤5 years. 42 (60%) and 28 (40%) patients belonged to early-onset and late-onset groups respectively. 35 (50%) patients were obese and median PASI score was 4.45. Mean 25-OHVD levels were 17.1±9.1 ng/mL. Comparative analysis revealed statistically significant differences between 25-OHVD levels (P=0.03), age (P<0.001), duration of psoriasis (P=0.01), use of oral steroids (P=0.01) and family history of psoriasis (P=0.04) of the two psoriatic groups. Stratified analysis disclosed males (P=0.003) who had disease for <5 years (P=0.01) suffered from PsA (P=0.03) were more affected with VDD in early-onset group.
Conclusion VDD is more frequent among early-onset plaque psoriasis cases. Cofactors associated with VDD are early age of presentation, lesser duration of disease, use of oral steroids and positive family history. Stratified analysis detected males of early-onset with disease duration of <5 years and having PsA were more often affected with vitamin D deficiency.
References
1. Menter A, Strober BE, KaplanDH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol.2019;80(4):1029-72.
doi: 10.1016/j.jaad.2018.11.057
2. Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512-6.
doi: 10.1016/j.jaad.2013.11.013
3. Mallick YA. Frequency of thyroid disorders in patients with chronic plaque psoriasis and psoriatic arthritis. J Pak Assoc Dermatol. 2019;29(2):182-7.
4. Al Dhubaibi MS. Association between Vitamin D deficiency and psoriasis: an exploratory study. Int J Health Sci (Qassim). 2018;12(1):33-9.
5. Maretzke F, Bechthold A, Egert S, Ernst JB, van Lent DM, Pilz S, et al. Role of vitamin D in preventing and treating selected extraskeletal diseases--an umbrella review. Nutrients.2020;12(4):969.
doi: 10.3390/nu12040969
6. Zittermann A, Pilz S. Vitamin D in klinik und praxis. Dtsch Med Wochenschr. 2017;142(8):601–16.
doi: 10.1055/s-0042-123788
7. Okazaki R, Ozono K, Fukumoto S, Inoue D, Yamauchi M, Minagawa M, et al. Assessment criteria for vitamin D deficiency/insufficiency in Japan: proposal by an expert panel supported by the Research Program of Intractable Diseases, Ministry of Health, Labour and Welfare, Japan, the Japanese Society for Bone and Mineral Research and the Japan Endocrine Society. J Bone Miner Metab.2017;35(1):1-5.
doi: 10.1007/s00774-016-0805-4
8. Schmitt J, Wozel G. The psoriasis area and severity index is the adequate criterion to define severity in chronic plaque-type psoriasis. Dermatology.2005;210(3):194-9. doi: 10.1159/000083509
9. Wen CP, David-Cheng TY, Tsai SP, Chan HT, Hsu HL, Hsu CC, et al. Are Asians at greater mortality risks for being overweight than Caucasians? Redefining obesity for Asians. Public Health Nutr.2009;12(4):497-506.
doi: 10.1017/S1368980008002802
10. Martens PJ, Gysemans C, Verstuyf A, Mathieu C. Vitamin D’s effect on immune function. Nutrients.2020;12(5):1248.
doi: 10.3390/nu12051248
11. Colotta F, Jansson B, Bonelli F. Modulation of inflammatory and immune responses by vitamin D. J Autoimmun.2017;85:78–97.
doi: 10.1016/j.jaut.2017.07.007
12. Pilz S, Zittermann A, Trummer C, Theiler-Schwetz V, Lerchbaum E, Keppel MH, et al. Vitamin D testing and treatment: a narrative review of current evidence. Endocr Connect. 2019;8(2):R27–R43.
doi: 10.1530/EC-18-0432
13. Trummer O, Schweighofer N, Haudum CW, Trummer C, Pilz S, Theiler-Schwetz V, et al. Genetic components of 25-hydroxyvitamin D increase in three randomized controlled trials. J Clin Med. 2020;9(2):570.
doi: 10.3390/jcm9020570
14. Ferreira GB, Gysemans CA, Demengeot J, da Cunha JP, Vanherwegen AS, Overbergh L, et al. 1,25-Dihydroxyvitamin D3 promotes tolerogenic dendritic cells with functional migratory properties in NOD mice. J Immunol.2014;192(9):4210–20.
doi: 10.4049/jimmunol.1302350
15. Wang Q, He Y, Shen Y, Zhang Q, Chen D, Zuo C, et al. Vitamin D inhibits COX-2 expression and inflammatory response by targeting thioesterase superfamily member 4. J Biol Chem.2014;289(17):11681–94.
doi: 10.1074/jbc.M113.517581
16. Zhang Y, Leung DY, Richers BN, Liu Y, Remigio LK, Riches DW, et al. Vitamin D inhibits monocyte/macrophage proinflammatory cytokine production by targeting MAPK phosphatase-1. J Immunol. 2012;188(5):2127–35.
doi: 10.4049/jimmunol.1102412
17. Kanikarla-Marie P, Jain SK. 1,25(OH)2D3 inhibits oxidative stress and monocyte adhesion by mediating the upregulation of GCLC and GSH in endothelial cells treated with acetoacetate (ketosis). J Steroid Biochem Mol Biol.2016;159:94–101.
doi: 10.1016/j.jsbmb.2016.03.002
18. Cantorna MT, Snyder L, Lin YD, Yang L. Vitamin D and 1,25(OH)2D regulation of T cells. Nutrients.2015;7(4):3011–21.
doi: 10.3390/nu7043011
19. Takiishi T, Van Belle T, Gysemans C, Mathieu C. Effects of vitamin D on antigen-specific and non-antigen-specific immune modulation: relevance for type 1 diabetes. Pediatr Diabetes.2013;14(2):81–9.
doi: 10.1111/j.1399-5448.2012.00923.x
20. Maleki M, Nahidi Y, Azizahari S, Meibodi NT, Hadianfar A. Serum 25 OH vitamin D level in psoriatic patients and comparison with control subjects. J Cutan Med Surg. 2016;20:207-10.
doi: 10.1177/1203475415622207
21. Chandrashekar L, Kumari GRK, Rajappa M, Revathy G, Munisamy M, Thappa DM. 25-hydroxy vitamin D and ischaemia-modified albumin levels in psoriasis and their association with disease severity. Br J Biomed Sci.2015;72(2):56-60.
doi: 10.1080/09674845.2015.11666797
22. Srirama L. Serum concentration of 25-hydroxy vitamin D in psoriatic patients in a tertiary care hospital: a case control study. Egypt J Dermatol Venerol.2016;36:29-33.
doi: 10.4103/1110-6530.202642
23. Orgaz-Molina J, Buendía-Eisman A, Arrabal-Polo MA, Ruiz JC, Arias-Santiago S. Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study. J Am Acad Dermatol. 2012;67(5):931-8.
doi: 10.1016/j.jaad.2012.01.040
24. Abdalla SA, Abdrabo AA. Assessment of 25-hydroxyvitamin D in serum of psoriatic Sudanese patients: a case-control study. Br J Med Health Res. 2015;2(1):17-22.
25. Pavlov S, Ivanova I, Gerova D. Vitamin D status in patients with psoriasis. Scr Sci Med. 2016;48(1):50-4.
doi: 10.14748/ssm.v1i1.1495
26. Zuchi MF, Azevedo PO, Tanaka AA, Schmitt JV, Martins LEAM. Serum levels of 25 hydroxy vitamin D in psoriatic patients. An Bras Dermatol.2015;90(3):430-2.
doi: 10.1590/abd1806-4841.20153524
27. Ricceri F, Pescitelli L, Tripo L, Prignano F. Deficiency of serum concentration of 25 hydroxyvitamin D correlates with severity of disease in chronic plaque psoriasis. J Am Acad Dermatol.2013;68:511-2.
doi: 10.1016/j.jaad.2012.10.051.
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