Department of Pediatrics, Rheumatology, Immunology, and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Clinical Hospital in Bialystok, Waszyngtona Street 17, 15274, Bialystok, Poland.
University Children's Clinical Hospital in Bialystok, Bialystok, Poland.
Rheumatol Int. 2023 Nov;43(11):1993-2009. doi: 10.1007/s00296-023-05411-5. Epub 2023 Aug 11.
Vitamin D, known for its essential role in calcium and bone homeostasis, has multiple effects beyond the skeleton, including regulation of immunity and modulation of autoimmune processes. Several reports have shown suboptimal serum 25 hydroxyvitamin D [25(OH)D] levels in people with different inflammatory and autoimmune rheumatic conditions, and an association between 25(OH)D levels, disease activity and outcomes. Although most available data pertain to adults, insights often are extended to children. Juvenile rheumatic diseases (JRDs) are a significant health problem during growth because of their complex pathogenesis, chronic nature, multisystemic involvement, and long-term consequences. So far, there is no definitive or clear evidence to confirm the preventive or therapeutic effect of vitamin D supplementation in JRDs, because results from randomized controlled trials (RCTs) have produced inconsistent outcomes. This review aims to explore and discuss the potential role of vitamin D in treating selected JRDs. Medline/PubMed, EMBASE, and Scopus were comprehensively searched in June 2023 for any study on vitamin D supplementary role in treating the most common JRDs. We used the following keywords: "vitamin D" combined with the terms "juvenile idiopathic arthritis", "juvenile systemic scleroderma", "juvenile systemic lupus erythematosus", "juvenile inflammatory myopathies", "Behcet disease", "periodic fever syndromes" and "juvenile rheumatic diseases". Observational studies have found that serum 25(OH)D concentrations are lower in juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, juvenile systemic scleroderma, Behcet disease and proinflammatory cytokine concentrations are higher. This suggests that vitamin D supplementation might be beneficial, however, current data are insufficient to confirm definitively the complementary role of vitamin D in the treatment of JRDs. Considering the high prevalence of vitamin D deficiency worldwide, children and adolescents should be encouraged to supplement vitamin D according to current recommendations. More interventional studies, especially well-designed RCTs, assessing the dose-response effect and adjuvant effect in specific diseases, are needed to determine the potential significance of vitamin D in JRDs treatment.
维生素 D 是钙和骨骼稳态所必需的，它具有多种作用，不仅限于骨骼，还包括调节免疫和调节自身免疫过程。有几项报告显示，患有不同炎症性和自身免疫性风湿性疾病的人群的血清 25 羟基维生素 D [25(OH)D]水平不理想，并且 25(OH)D 水平与疾病活动度和结局之间存在关联。尽管大多数现有数据都涉及成年人，但这些见解通常也适用于儿童。青少年风湿性疾病 (JRD) 是生长过程中的一个重大健康问题，因为其发病机制复杂、慢性、多系统受累和长期后果。到目前为止，尚无明确或明确的证据证实维生素 D 补充在 JRD 中的预防或治疗作用，因为随机对照试验 (RCT) 的结果产生了不一致的结果。本综述旨在探讨和讨论维生素 D 在治疗某些 JRD 中的潜在作用。2023 年 6 月，在 Medline/PubMed、EMBASE 和 Scopus 上全面搜索了关于维生素 D 在治疗最常见 JRD 中的补充作用的任何研究。我们使用了以下关键词：“维生素 D”与“青少年特发性关节炎”、“青少年系统性硬皮病”、“青少年系统性红斑狼疮”、“青少年炎症性肌病”、“贝切特病”、“周期性发热综合征”和“青少年风湿性疾病”相结合。观察性研究发现，血清 25(OH)D 浓度在青少年特发性关节炎、青少年系统性红斑狼疮、青少年系统性硬皮病、贝切特病和促炎细胞因子浓度较高。这表明维生素 D 补充可能有益，然而，目前的数据不足以明确证实维生素 D 在 JRD 治疗中的补充作用。考虑到全球维生素 D 缺乏症的高患病率，应根据当前建议鼓励儿童和青少年补充维生素 D。需要更多的干预性研究，特别是设计良好的 RCT，评估特定疾病中的剂量反应效应和辅助作用，以确定维生素 D 在 JRD 治疗中的潜在意义。
