Lupus Sci Med 1:e000011 doi:10.1136/lupus-2014-000011
  • Epidemiology and outcomes

Vitamin D deficiency is common and associated with increased C-reactive protein in children and young adults with lupus: an Atherosclerosis Prevention in Pediatric Lupus Erythematosus substudy

  1. for the APPLE investigators
  1. 1Department of Pediatrics, Rainbow Babies and Children's Hospital/Case Medical Center, Cleveland, Ohio, USA
  2. 2Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Duke Clinical Research Institute, Durham, North Carolina, USA
  4. 4Department of Medicine and Pediatrics, Case Medical Center, Cleveland, Ohio, USA
  5. 5Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
  1. Correspondence to Dr Angela Byun Robinson; angela.robinson{at}


Objective Epidemiological associations suggest vitamin D may play a role in inflammation and atherosclerosis. Using frozen serum and data from the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial, we assessed associations between 25-hydroxyvitamin D [25(OH)D] and measures of systemic lupus erythematosus (SLE) disease activity and cardiovascular risk.

Methods Baseline APPLE serum samples were used to measure 25(OH)D levels. Logistic regression models for vitamin D deficiency [25(OH)D levels <20 ng/mL] were constructed using baseline variables collected as part of the trial, including race, season, latitude, disease duration, disease activity, high-sensitivity C-reactive protein (hsCRP), proteinuria, fasting lipids and carotid intima medial thickness (CIMT).

Results Samples were available from 201 of 221 APPLE subjects; 61/201 (30%) had vitamin D deficiency at baseline. In univariable analysis, baseline vitamin D deficiency was associated with season (p<0.01), minority status (p<0.01), body mass index (p=0.04), duration of SLE (p<0.01), SLICC damage index (p=0.04), hsCRP (p<0.01), mean–max CIMT (p=0.01), LDL-cholesterol (p=0.03) and timed urine protein (p=0.03). In multivariable modelling, vitamin D deficiency was associated with age, latitude, season, minority status, proteinuria and hsCRP.

Conclusions Vitamin D deficiency is common in paediatric lupus and is independently associated with elevated hsCRP, a marker of inflammation that predicts cardiovascular disease risk. Although association is not proof of causation, this association is novel in the paediatric SLE population and suggests that vitamin D deficiency may contribute to heightened inflammation and cardiovascular risk in this population.

Trial register number NCT00065806.

  • Received January 9, 2014.
  • Revision received April 4, 2014.
  • Accepted April 5, 2014.
  • Published 1 May 2014

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