TY - JOUR
T1 - The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset
AU - on behalf of the RKD and UKIVAS groups
AU - Scott, Jennifer
AU - Havyarimana, Enock
AU - Navarro-Gallinad, Albert
AU - White, Arthur
AU - Wyse, Jason
AU - van Geffen, Jos
AU - van Weele, Michiel
AU - Buettner, Antonia
AU - Wanigasekera, Tamara
AU - Walsh, Cathal
AU - Aslett, Louis
AU - Kelleher, John D.
AU - Power, Julie
AU - Ng, James
AU - O’Sullivan, Declan
AU - Hederman, Lucy
AU - Basu, Neil
AU - Little, Mark A.
AU - Zgaga, Lina
AU - Lavin, Peter
AU - Wall, Catherine
AU - Mellotte, George
AU - Fitzgerald, Ted
AU - O’Keefe, Hannah
AU - Dilworth, Rachel
AU - O’Neill, Pamela
AU - Carr, Vicki
AU - Conlon, Niall
AU - Griffin, Brenda
AU - Sexton, Donal
AU - Kosgei, Caroline
AU - O’Meara, Yvonne
AU - White, Eoghan
AU - Mahony, Stephen
AU - Molloy, Eamonn
AU - Holian, John
AU - Griffin, Matt
AU - Lappin, David
AU - Judge, Conor
AU - Cormican, Sarah
AU - O’Connell, Blathnaid
AU - Clince, Michelle
AU - Casserly, Liam
AU - Clarkson, Michael
AU - O’Shaughnessy, Michelle
AU - Verrelli, Alyssa
AU - Stoeman, Sinead
AU - Daly, Fergus
AU - Slattery, Laura
AU - Murphy, Aisling
N1 - Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - ANCA-associated vasculitis
KW - Environment
KW - Geoepidemiology
KW - Ultraviolet B (UVB) radiation
KW - Vitamin D
UR - http://www.scopus.com/inward/record.url?scp=85132330116&partnerID=8YFLogxK
U2 - 10.1186/s13075-022-02834-6
DO - 10.1186/s13075-022-02834-6
M3 - Article
C2 - 35717248
AN - SCOPUS:85132330116
SN - 1478-6354
VL - 24
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 1
M1 - 147
ER -