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Background and Objectives: Vitamin D is a secosteroid hormone essential for calcium homeostasis and skeletal health, but established evidence highlights its significant roles also in muscle health and in the modulation of immune response. This review aims to explore the impact of impaired vitamin D status on outcomes of muscle function and involvement in inflammatory and autoimmune rheumatic diseases damaging the skeletal muscle efficiency both with direct immune-mediated mechanisms and indirect processes such as sarcopenia. Methods: A comprehensive literature search was conducted on PubMed and Medline using Medical Subject Headings (MeSH) terms: "vitamin D, muscle, rheumatic diseases." Additionally, conference abstracts from The European Alliance of Associations for Rheumatology (EULAR) and the American College of Rheumatology (ACR) (2020–2023) were reviewed, and reference lists of included papers were scanned. The review emphasizes the evidence published in the last five years, while also incorporating significant studies from earlier years, structured by the extent of evidence linking vitamin D to muscle health in the most commonly inflammatory and autoimmune rheumatic diseases encountered in clinical practice. Results: Observational studies indicate a high prevalence of vitamin D serum deficiency (mean serum concentrations < 10 ng/mL) or insufficiency (<30 ng/mL) in patients with idiopathic inflammatory myopathies (IIMs) and polymyalgia rheumatica, as well as other autoimmune connective tissue diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Of note, vitamin D insufficiency may be associated with reduced muscle strength (2 studies on RA, 2 in SLE and 1 in SSc), increased pain (1 study on SLE), fatigue (2 studies on SLE), and higher disease activity (3 studies on IIMs and 1 on SLE) although there is much heterogeneity in the quality of evidence and different associations for the different investigated diseases. Therefore, linked to the multilevel biological intervention exerted by vitamin D, several translational and clinical studies suggest that active metabolites of this secosteroid hormone, play a role both in reducing inflammation, but also in enhancing muscle regeneration, intra-cellular metabolism and mitochondrial function, although interventional studies are limited. Conclusions: Altered serum vitamin D status is commonly observed in inflammatory and autoimmune rheumatic diseases and seems to be associated with adverse muscle health outcomes. While maintaining adequate serum vitamin D concentrations may confer muscle-protective effects, further research is needed to confirm these findings and establish optimal supplementation strategies to obtain a safe and efficient serum threshold. [ABSTRACT FROM AUTHOR]

Objective: This study aims to evaluate blood perfusion (BP) in various cutaneous regions of the hands and face in patients with systemic lupus erythematosus (SLE) and primary Raynaud's phenomenon (PRP) and healthy subjects (HS). Methods: A total of 20 patients with SLE, 20 patients with PRP, and 20 HS were enrolled. BP was detected by laser speckle contrast analysis in different regions of the hand and at the facial level. The absolute nailfold capillary number (CN) was assessed by nailfold videocapillaroscopy. Results: Patients with SLE and PRP had significantly lower BP levels than those of HS in 3 hand areas (fingertip, palm, and periungual; p<0.01). However, the SLE, PRP, and HS groups had comparable BP values at the hand dorsum and face. The BP and CN values revealed a positive correlation in the periungual, fingertip, and palm of hands (p<0.01), only in patients with SLE. Conclusion: Our data demonstrated a correlation between functional and morphological microvascular impairment in patients with SLE. [ABSTRACT FROM AUTHOR]

Objectives Urinary tract involvement is a seldom-reported manifestation of SSc that could compromise patients' quality of life. This study compares lower urinary tract symptoms (LUTS) in SSc patients and in healthy subjects and their association with clinical and diagnostic parameters. Methods LUTS were assessed through self-reported questionnaires in 42 SSc patients and 50 matched healthy subjects. Statistical analyses were performed to explore LUTS in the two populations and their association with SSc variables, including nailfold videocapillaroscopy patterns, SSc-related antibodies and DXA parameters. Results SSc patients showed significantly higher prevalence and severity of urinary incontinence (UI) and overactive bladder (OAB) than healthy controls (P < 0.005, P < 0.01). SSc was a strong predictor of LUTS, independent of demographic data, comorbidities and treatments (odds ratio 5.57, 95% CI 1.64–18.88). In SSc patients OAB positively correlated with sarcopenia (P < 0.001), and both OAB and UI significantly correlated with reduced BMD (P < 0.05, P = 0.001). UI positively correlated with Scl70 antibodies (P < 0.05) and ciclosporin treatment (P = 0.001) and negatively with RNA polymerase III antibodies (P < 0.05); OAB positively correlated with calcinosis (P < 0.005) and negatively with methotrexate treatment (P < 0.05). Nailfold videocapillaroscopy 'active' and 'late' patterns were predominant among SSc patients presenting urinary symptoms, although no statistical correlation was found. Conclusion For the first time urinary tract involvement was found to be significantly higher in SSc patients than in healthy matched controls. In addition, sarcopenia, bone damage and calcinosis appeared significantly correlated with LUTS, suggesting a possible interplay. [ABSTRACT FROM AUTHOR]

The patients under liver transplant are always affected by osteometabolic secondary disease, which is linked with an epatic based damage, surgeon operation, pharmacologic transplant treatment and patient immobility. The candidates for liver transplant must follow the diagnostical- therapeutic iter for osteoporosis in order to prevent the risk of spine hurt above all until the fracture which is a limit for a patient's recovery after the transplant. Six months after the transplant there is an impact of BMD decrease; for this reason these patients in the presurgery need on added therapy about calcium-25 (OH)D and antireabsorptive that had an important result to prevent the fracture. The clinic case showed that Teriparatide therapy is efficient on prevent the BMD decrease without fracture and pain. [ABSTRACT FROM AUTHOR]

Chronic rheumatological diseases are multifactorial conditions in which both the neuroendocrine hormone pathway, including cortisol, sex hormones and active vitamin D3 (calcitriol), all deriving from cholesterol, and the epigenetic modifications that they cause play an important role. In fact, epigenetics modulates the function of the DNA of immune cells, through three main mechanisms: DNA methylation, modifications to the histones that make up chromatin and production of non-coding RNAs (microRNA - miRNA). In this narrative review, the main data regarding the epigenetic modifications induced by cortisol, 17β-oestradiol, progesterone, testosterone and calcitriol on immune cells were collected, discussing how these can interfere in the predisposition and course of chronic rheumatological diseases (i.e. rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis). An ever-increasing number of miRNAs have been identified, which are produced by neuroendocrine hormones and can influence the inflammatory-fibrotic response at various levels. Concerning the involvements of the neuro-endocrine-immunology within the pathophysiology of rheumatic diseases, the epigenetic effects induced by steroid hormones must be taken into consideration to evaluate their impact on the progression of the single condition and even inside the single patient.

Objectives: Systemic sclerosis (SSc) is characterised by microvascular inflammatory damage, loss of capillaries and progressive systemic fibrosis. Capillary rarefaction may precede sarcopenia, we therefore evaluated the body composition and occurrence of sarcopenia in SSc patients, in relation to the peripheral microcirculatory status, assessed and scored by nailfold videocapillaroscopy (NVC) patterns, including capillary number count and microangiopathy evolution score (MES)., Methods: Body composition and bone mineral density were assessed by Dual X-ray absorptiometry and a dedicated software (GE Lunar, USA) in 43 SSc patients (age 64.1 ± 11.2 yrs, 83.7% women) affected by limited or diffuse cutaneous (74.4%) according to the 2013 EULAR/ACR criteria and 43 age-matched healthy subjects (HS). Sarcopenia was checked as relative skeletal muscle index (RSMI). Clinical, laboratory, body composition and bone parameters were analysed according to the different NVC patterns and MES. Means were compared by the Student's t test or by one way analysis of variance; medians were compared by the Kruskall Wallis test; and frequencies by the chi square test., Results: Sarcopenia was found in 23.26% of SSc patients with a prevalence significantly higher than age matched HS (4.65%; p = 0.03). Interestingly, SSc patients with "late" NVC pattern showed a significantly higher prevalence of sarcopenia (43.75%) compared to "early" (9.1%) and "active" (12.5%) NVC patterns (p<0.0002). In addition, capillary density was found significantly lower in sarcopenic versus non sarcopenic patients (4.4±1.8 vs. 5.8±2.2, p<0.05). Finally, MES showed significantly most severe score in sarcopenic SSc patients (p<0.001): peripheral blood flow analised in a sample of sarcopenic SSc patients by Laser speckle contrast analysis (LASCA) showed lowest values (p<0.05). Total mass (TM), lean mass (LM), fat mass (FM) and bone mineral content (BMC) values were found significantly lower in sarcopenic SSc patients (p<0.0001, p<0.001, p=0.004, p=0.04, respectively)., Conclusions: SSc patients with sarcopenia and altered body composition were found affected by the most severe NVC pattern ("late"), a significantly reduced/altered number of capillaries and microvascular array (MES), suggesting a strong link between severity of local microvascular failure and associated muscle sufferance.