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

Scott, J; Havyarimana, E; Navarro-Gallinad, A; White, A; Wyse, J; van Geffen, J; van Weele, M; Buettner, A; Wanigasekera, T; Walsh, C; Aslett, LJM; Kelleher, JD; Power, J; Ng, J; O’Sullivan, D; Hederman, L; Basu, N; Little, MA; Zgaga, L; and UKIVAS groups, RKD

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Authors

J Scott

E Havyarimana

A Navarro-Gallinad

A White

J Wyse

J van Geffen

M van Weele

A Buettner

T Wanigasekera

C Walsh

JD Kelleher

J Power

J Ng

D O’Sullivan

L Hederman

N Basu

MA Little

L Zgaga

RKD and UKIVAS groups



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.

Citation

Scott, J., Havyarimana, E., Navarro-Gallinad, A., White, A., Wyse, J., van Geffen, J., …and UKIVAS groups, R. (2022). The association between ambient UVB dose and ANCA-associated vasculitis relapse and onset. Arthritis Research and Therapy, 24(1), Article 147. https://doi.org/10.1186/s13075-022-02834-6

Journal Article Type Article
Acceptance Date Jun 3, 2022
Online Publication Date Jun 18, 2022
Publication Date 2022
Deposit Date Jun 24, 2022
Publicly Available Date Mar 29, 2024
Journal Arthritis Research & Therapy
Print ISSN 1478-6354
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 24
Issue 1
Article Number 147
DOI https://doi.org/10.1186/s13075-022-02834-6

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http://creativecommons.org/licenses/by/4.0/

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This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.




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