The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset

Scott, J. et al. (2022) The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset. Arthritis Research and Therapy, 24(1), 147. (doi: 10.1186/s13075-022-02834-6) (PMID:35717248) (PMCID:PMC9206351)

Abstract

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.

• Item Type: Articles
• Additional Information: Dr. Jennifer Scott is a Wellcome-HRB Irish Clinical Academic Training (ICAT) Fellow, and this work was performed within the Irish Clinical Academic Training (ICAT) Programme, supported by the Wellcome Trust and the Health Research Board (Grant Number 203930/B/16/Z), the Health Service Executive, National Doctors Training and Planning and the Health and Social Care, Research and Development Division, Northern Ireland. MAL received funding from Health Research Board/Irish Nephrology Society (MRCG-2016-12) and Science Foundation Ireland (13/RC/2106_P2 and 11/YI/B2093). ANG and EH received funding from the European Union’s Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 813545.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Havyarimana, Enock and Basu, Professor Neil
• Authors: Scott, J., Havyarimana, E., Navarro-Gallinad, A., White, A., Wyse, J., van Geffen, J., van Weele, M., Buettner, A., Wanigasekera, T., Walsh, C., Aslett, L., Kelleher, J. D., Power, J., Ng, J., O’Sullivan, D., Hederman, L., Basu, N., Little, M. A., and Zgaga, L.
• College/School: College of Medical Veterinary and Life Sciences; College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Research Centre: College of Medical Veterinary and Life Sciences > School of Infection & Immunity > Centre for Immunobiology
• Journal Name: Arthritis Research and Therapy
• Publisher: BioMed Central
• ISSN: 1478-6354
• ISSN (Online): 1478-6362
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Arthritis Research and Therapy 24(1):147
• Publisher Policy: Reproduced under a Creative Commons License