#28) CASE HISTORY: MARKED IMPROVEMENT IN SCLERODERMA WITH TREATMENT OF VITAMIN D DEFICIENCY

(revised August 26, 2013) (revised November 14, 2013)

Kathy is a lady who was diagnosed with scleroderma in January, 2005 at the age of 45. Her initial illness was very serious; she was in acute renal failure as a result of it, and was on hemodialysis for months. She has been under the care of a rheumatologist and is on multiple medications including prednisone from early on. The first several years, in addition to her acute renal failure, she lost the fingers of her right hand, a characteristic manifestation of scleroderma. She also suffered from severe chronic fatigue.

Scleroderma is a rare disease and I have seen only a small number of patients with the condition during my career. However I know it is thought to be a disease caused by the production of abnormal antibodies. I also knew that studies had been done previously that showed that scleroderma is associated with very low vitamin D levels. This was not a surprise when I learned this, since scleroderma is a connective tissue diseases like rheumatoid arthritis, systemic lupus, and Sjogren’s syndrome also shown to be associated with very low vitamin D levels, lower than the general healthy population; and in some cases medical research studies showed an improvement of symptoms with these illnesses with the treatment of vitamin D deficiencies.

I first saw her as a patient in January, 2010. I told her it may be important to get a 25-hydroxyvitamin D level. The results showed a level of 15 nanograms (ng.), equivalent to 22.5 nMol., (a unit more commonly used in Great Britain).  I started her on 50,000 units of vitamin D2 a week, (an average of 7143 units a day). Vitamin D2 is a prescription drug in the United States.  An alternative dose of 5,000 units of Vitamin D3 daily can be used also ( a total of 35,000 units a week). Vitamin D3 is over the counter, and in the United States is extremely inexpensive ($2 a month in a prominent chain pharmacy).  In my practice of medicine, I have over 7,000 patients with vitamin D insufficiency or deficiency who are on this dose of vitamin D2 or D3.)

She continued to see her rheumatologist and primary care doctor. I saw her again on May 2, 2012. She told me that within a few months of starting the vitamin D, her years of fatigue improved and then resolved. Her kidney function before the vitamin D showed a creatinine of 1.4 mg.; a recent one was now 1.2 mg. In September, 2013, it improved significantly further to a level of 0.8 mg.  Her creatinine is now normal.  It has improved 42.8%.  (Serum creatinine is a very important measure of kidney function, and renal impairment  sometimes occurs with scleroderma).  Immediately prior to the vitamin D, her prednisone dose as prescribed by her rheumatologist, was 40 mg. a day. Once the vitamin D was started, because of an improvement in her overall symptoms, her doctor was able to slowly the dose to 5 mg. a day. (40 mg. of Prednisone a day for an extended period of time almost always causes major serious side effects; in comparison 5 mg. is associated with much less severe side effects). Since 2010, Kathy has had follow up levels of 25-hydroxyvitamin D and the level indicates a sufficient level.

On May 11, 2011, I posted: #19, a case history regarding myasthenia gravis (MG) and vitamin D.. and since then it's been updated. http://robertbakermdhealthnewsletter.blogspot.com/2013/06/35-index-case-of-improvement-of.html  This is the first case history ever reported of MG being treated and improving with vitamin D.  On July 1, 2010, I posed a case history of a complete remission of progressive multiple sclerosis with Vitamin D, a remission that is still complete as of June, 2013.. However in this case, there is a large volume of medical studies that have documented improvement of MS with Vitamin D. Many have been published AFTER my report of 2010, but many were published before. 

So is this case report of scleroderma more similar to a new finding in the case of MG, or just a demonstration of a previously discovered connection, as in the case of MS? To find out, I had to search the internet.

Vitamin D levels in scleroderma have been found to be remarkably low. There is direct correlation between the severity of the disease and levels of vitamin D. Especially important is that lung manifestations of scleroderma are more common and severe the lower the level. Fibrosis (scar tissue) which can be widespread in advanced scleroderma has been show to be inversely related to vitamin D concentration. The abnormal deposition of calcium deposits in the tissues (called metastatic calcification), found in the most severe cases of scleroderma, is related to high parathyroid levels and very low vitamin D levels om patients without scleroderma, and a study that looked at parathyroid levels found in fact that parathyroid levels in scleroderma was very high. As far as case reports, there are some, but not the “perfect” prospective double blind study.

There are various theories about some of the causes of scleroderma, not having anything to do with vitamin D.  But the theory based on substantial evidence with medical studies is that vitamin D prevents the production of abnormal antibodies caused by a wide variety of illnesses,

Most people reading this do not know anyone with scleroderma because fortunately it is a rare disease. But everyone knows someone with an autoimmune disease. Help them out, send this link to them.