International Journal of Rheumatic Diseases 2014; 17: 479–480
CORRESPONDENCE
Vitamin D levels in patients with Behcßet’s disease Dear Editor, We read the article ‘The status of serum vitamin D in patients with active Behcet’s disease compared with controls’ written by Khabbazi et al.1 with great interest. They aimed to investigate the status of vitamin D in patients with active and recently diagnosed Behcet’s disease (BD) and the relationship between vitamin D levels and BD activity. They concluded there was a relationship between vitamin D levels and BD activity. Vitamin D has generated considerable interest as potentially having important effects on the vascular system. The mechanism underlying the inverse relationship between vitamin D levels and BD activity is not completely understood. Inreased inflammatory response in BD may lead to endothelial dsyfunction.2 Vitamin D level is the most important condition for musculoskeletal systems in children. However, vitamin D level has been shown to be related to higher inflammatory status in adults. Insufficient vitamin D levels were detected in many chronic illnesses, including coronary artery disease,3 diabetes mellitus,4 systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, psoriasis, malignancy and infectious diseases. They are also related to the markers of oxidative stress, inflammation and endothelial activation in adult individuals. Inflammatory conditions can also be affected by atherosclerotic risk factors, such as smoking, alcohol consumption, hypercholesterolemia, cerebrovascular disease, peripheral arterial disease and hypothyroidism. In this context, the authors did not mention some of the factors affecting these markers in their study. Additionally, obstructive sleep apnea syndrome (OSAS) may be associated with increased cardiovascular morbidity and mortality based on inflammation. Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is common in overweight/obese people and may have an association with higher inflammatory status.5 For this reason, it would be better if the authors had mentioned these factors. Furthermore, some medications such as antihypertensive treatment, including angiotensin-converting enzyme
inhibitors, angiotensin receptor blockers, statins and anti-inflammatory drugs may influence vitamin D levels.6 It would have been useful if the authors had described these factors. As a conclusion, vitamin D levels in the BD group were lower than the control group as presented in their study; however, the level of vitamin D can be affected by many conditions and further studies should evaluate all of these conditions that can affect vitamin D levels in patients with BD. Thanks to the authors for their contribution to the literature.
CONFLICT OF INTEREST There is no conflict of interests. Ilknur BALTA,1 Sevket BALTA,2 Sait DEMIRKOL,2 Mustafa DEMIR2 and Turgay CELIK2 1
Department of Dermatology, Kecioren Training and Research Hospital, and 2Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey Correspondence: Dr Sevket Balta, email: [email protected]
REFERENCES 1 Khabbazi A, Rashtchizadeh N, Ghorbanihaghjo A, Ghojazadeh M, Taei R, Kolahi S (2013) The status of serum vitamin D in patients with active Behcet ‘s disease compared with controls. Int J Rheum Dis, doi: 10.1111/ 1756-185X.12153. [Epub ahead of print]. 2 Balta I, Balta S, Koryurek OM et al. (2013) Serum endocan levels as a marker of disease activity in patients with Behcßet’s disease. J Am Acad Dermatol 70, 291–96. 3 Cakar M, Arslan E, Demirkol S, Kurt O, Balta S, Arslan Z (2013) Levels of vitamin D and its effects on bone metabolism and cardiovascular system should be assessed after isolation of confounding factors. Int J Cardiol 168, 628. 4 Kurt O, Balta S, Cakar M, Arslan E, Unlu M, Demirkol S (2013) The protectiveness of the treatment of vitamin D insufficiency in the development of diabetes. Arq Bras Endocrinol Metabol 57 (2), 157–8.
© 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
Correspondence
5 Balta S, Demirkol S, Ay SA, Kurt O, Unlu M, Celik T (2013) Nonalcoholic fatty liver disease may be associated with coronary artery disease complexity. Angiology 64, 639–40. 6 Ay SA, Karaman M, Cakar M et al. (2013) Amlodipine increases vitamin D levels more than valsartan in newly
480
diagnosed hypertensive patients: pointing to an additional effect on bone metabolism or a novel marker of inflammation? Ren Fail 35, 691–6.
International Journal of Rheumatic Diseases 2014; 17: 479–480
Copyright of International Journal of Rheumatic Diseases is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
CORRESPONDENCE
Vitamin D levels in patients with Behcßet’s disease Dear Editor, We read the article ‘The status of serum vitamin D in patients with active Behcet’s disease compared with controls’ written by Khabbazi et al.1 with great interest. They aimed to investigate the status of vitamin D in patients with active and recently diagnosed Behcet’s disease (BD) and the relationship between vitamin D levels and BD activity. They concluded there was a relationship between vitamin D levels and BD activity. Vitamin D has generated considerable interest as potentially having important effects on the vascular system. The mechanism underlying the inverse relationship between vitamin D levels and BD activity is not completely understood. Inreased inflammatory response in BD may lead to endothelial dsyfunction.2 Vitamin D level is the most important condition for musculoskeletal systems in children. However, vitamin D level has been shown to be related to higher inflammatory status in adults. Insufficient vitamin D levels were detected in many chronic illnesses, including coronary artery disease,3 diabetes mellitus,4 systemic lupus erythematosus, rheumatoid arthritis, multiple sclerosis, psoriasis, malignancy and infectious diseases. They are also related to the markers of oxidative stress, inflammation and endothelial activation in adult individuals. Inflammatory conditions can also be affected by atherosclerotic risk factors, such as smoking, alcohol consumption, hypercholesterolemia, cerebrovascular disease, peripheral arterial disease and hypothyroidism. In this context, the authors did not mention some of the factors affecting these markers in their study. Additionally, obstructive sleep apnea syndrome (OSAS) may be associated with increased cardiovascular morbidity and mortality based on inflammation. Non-alcoholic fatty liver disease (NAFLD), the most common liver disease, is common in overweight/obese people and may have an association with higher inflammatory status.5 For this reason, it would be better if the authors had mentioned these factors. Furthermore, some medications such as antihypertensive treatment, including angiotensin-converting enzyme
inhibitors, angiotensin receptor blockers, statins and anti-inflammatory drugs may influence vitamin D levels.6 It would have been useful if the authors had described these factors. As a conclusion, vitamin D levels in the BD group were lower than the control group as presented in their study; however, the level of vitamin D can be affected by many conditions and further studies should evaluate all of these conditions that can affect vitamin D levels in patients with BD. Thanks to the authors for their contribution to the literature.
CONFLICT OF INTEREST There is no conflict of interests. Ilknur BALTA,1 Sevket BALTA,2 Sait DEMIRKOL,2 Mustafa DEMIR2 and Turgay CELIK2 1
Department of Dermatology, Kecioren Training and Research Hospital, and 2Department of Cardiology, Gulhane Medical Academy, Ankara, Turkey Correspondence: Dr Sevket Balta, email: [email protected]
REFERENCES 1 Khabbazi A, Rashtchizadeh N, Ghorbanihaghjo A, Ghojazadeh M, Taei R, Kolahi S (2013) The status of serum vitamin D in patients with active Behcet ‘s disease compared with controls. Int J Rheum Dis, doi: 10.1111/ 1756-185X.12153. [Epub ahead of print]. 2 Balta I, Balta S, Koryurek OM et al. (2013) Serum endocan levels as a marker of disease activity in patients with Behcßet’s disease. J Am Acad Dermatol 70, 291–96. 3 Cakar M, Arslan E, Demirkol S, Kurt O, Balta S, Arslan Z (2013) Levels of vitamin D and its effects on bone metabolism and cardiovascular system should be assessed after isolation of confounding factors. Int J Cardiol 168, 628. 4 Kurt O, Balta S, Cakar M, Arslan E, Unlu M, Demirkol S (2013) The protectiveness of the treatment of vitamin D insufficiency in the development of diabetes. Arq Bras Endocrinol Metabol 57 (2), 157–8.
© 2013 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd
Correspondence
5 Balta S, Demirkol S, Ay SA, Kurt O, Unlu M, Celik T (2013) Nonalcoholic fatty liver disease may be associated with coronary artery disease complexity. Angiology 64, 639–40. 6 Ay SA, Karaman M, Cakar M et al. (2013) Amlodipine increases vitamin D levels more than valsartan in newly
480
diagnosed hypertensive patients: pointing to an additional effect on bone metabolism or a novel marker of inflammation? Ren Fail 35, 691–6.
International Journal of Rheumatic Diseases 2014; 17: 479–480
Copyright of International Journal of Rheumatic Diseases is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
