期刊
ARTHRITIS RESEARCH & THERAPY
卷 24, 期 1, 页码 -出版社
BMC
DOI: 10.1186/s13075-022-02834-6
关键词
ANCA-associated vasculitis; Ultraviolet B (UVB) radiation; Vitamin D; Environment; Geoepidemiology
类别
资金
- Wellcome Trust
- Health Research Board [203930/B/16/Z]
- Health Service Executive, National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland
- Health Research Board/Irish Nephrology Society [MRCG-2016-12]
- Science Foundation Ireland [13/RC/2106_P2, 11/YI/B2093]
- European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant [813545]
- Health Research Board (HRB) [MRCG-2016-12] Funding Source: Health Research Board (HRB)
- Science Foundation Ireland (SFI) [11/YI/B2093] Funding Source: Science Foundation Ireland (SFI)
This study found that low winter ambient UVB and prolonged vitamin D deficiency are associated with an increased risk of AAV relapse across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly mediated by vitamin D. Further research is needed to determine if sufficient vitamin D status could reduce relapse propensity in AAV.
Background The aetiology of ANCA-associated vasculitis (AAV) and triggers of relapse are poorly understood. Vitamin D (vitD) is an important immunomodulator, potentially responsible for the observed latitudinal differences between granulomatous and non-granulomatous AAV phenotypes. A narrow ultraviolet B spectrum induces vitD synthesis (vitD-UVB) via the skin. We hypothesised that prolonged periods of low ambient UVB (and by extension vitD deficiency) are associated with the granulomatous form of the disease and an increased risk of AAV relapse. Methods Patients with AAV recruited to the Irish Rare Kidney Disease (RKD) (n = 439) and UKIVAS (n = 1961) registries were studied. Exposure variables comprised latitude and measures of ambient vitD-UVB, including cumulative weighted UVB dose (CW-D-UVB), a well-validated vitD proxy. An n-of-1 study design was used to examine the relapse risk using only the RKD dataset. Multi-level models and logistic regression were used to examine the effect of predictors on AAV relapse risk, phenotype and serotype. Results Residential latitude was positively correlated (OR 1.41, 95% CI 1.14-1.74, p = 0.002) and average vitD-UVB negatively correlated (0.82, 0.70-0.99, p = 0.04) with relapse risk, with a stronger effect when restricting to winter measurements (0.71, 0.57-0.89, p = 0.002). However, these associations were not restricted to granulomatous phenotypes. We observed no clear relationship between latitude, vitD-UVB or CW-D-UVB and AAV phenotype or serotype. Conclusion Our findings suggest that low winter ambient UVB and prolonged vitD status contribute to AAV relapse risk across all phenotypes. However, the development of a granulomatous phenotype does not appear to be directly vitD-mediated. Further research is needed to determine whether sufficient vitD status would reduce relapse propensity in AAV.
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