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Dear Dr Cannell: Severe infection in rheumatoid arthritis

Posted on: May 14, 2013   by  John Cannell, MD

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Dear Dr. Cannell:

I am one of your subscribers and am writing to ask for your input regarding the case of a close friend’s 58 year old wife’s serious medical condition, which I will summarize here.

She is a 50 year-old Caucasian woman, who has had Crohn’s disease and rheumatoid arthritis for 20 years.  She has an artificial hip joint. An opportunistic staph infection arose 4 weeks ago in the hip. Her joint was rebuilt 3 weeks ago, and cleaned out removing large amounts of pus, while installing antibiotic pellets. She has also received IV antibiotic therapy 3 times per day for the last 3 weeks.

The doctors have stopped her arthritis medications and the rheumatoid arthritis symptoms are bad. The wound is still weeping and not healing, indicating infection continues. While the white count is now reduced, infection is not deemed under control.

She was tested for vitamin D 4 weeks ago and the level was very low. Her doctors continue to refuse to administer vitamin D to her, claiming insignificance. They are considering a drastic surgery to permanently remove her hip (which would make her leg eight inches shorter) as well as giving her hyperbaric oxygen therapy.

I am hoping that you might be able to consult with her doctors.  The patient’s highly educated husband is very open to vitamin D therapy but her doctors are not. What can the husband do?

Thank You,

Tony, New Mexico

Dear Tony:

I am sorry for your friend. I can’t offer medical advice per your request, obviously, but I can provide information on what some research shows.

She appears to have at least three conditions that vitamin D may or may not help: infection, Crohn’s disease, and rheumatoid arthritis. And a final condition that vitamin D will help: vitamin D deficiency.

The evidence that vitamin D will help infections were recently reviewed in two separate publications, with the conclusion that vitamin D deficiency in infection is probably contributing to the seriousness of the infection. Vitamin D increases the body’s production of a number of naturally occurring antibiotics called antimicrobial peptides.

Lang PO, Samaras N, Samaras D, Aspinall R.  How important is vitamin D in preventing infections? Osteoporos Int. 2012 Nov 17.

Hewison M. Antibacterial effects of vitamin D. Nat Rev Endocrinol. 2011 Jun;7(6):337-45. doi: 10.1038/nrendo.2010.226. Epub 2011 Jan 25. Review.

Likewise, two recent reviews pointed to the remarkably strong likelihood that autoimmune disorders such as Crohn’s disease and rheumatoid arthritis will respond to vitamin D.

Antico A, Tampoia M, Tozzoli R, Bizzaro N. Can supplementation with vitamin D reduce the risk or modify the course of autoimmune diseases? A systematic review of the literature. Autoimmun Rev. 2012 Dec;12(2):127-36.

Agmon-Levin N, Theodor E, Segal RM, Shoenfeld Y. Vitamin D in Systemic and Organ-Specific Autoimmune Diseases. Clin Rev Allergy Immunol. 2012 Dec 14

Now the bad news: I cannot interfere in the management of this case by calling her doctors. I would however, be glad to speak with any of her doctors should they call me.

Also, the husband always has the option to interfere in the case. They do make both 50,000 IU and 5,000 IU capsules at Bio Tech Pharmacal, the former which can be used as a loading dose to quickly raise vitamin D levels, the latter which can be used to maintain vitamin D status. While it’s unlikely that vitamin D will improve her health dramatically, if she does recover, she should find a physician who reads the current medical literature and understands the importance of a good vitamin D level.

4 Responses to Dear Dr Cannell: Severe infection in rheumatoid arthritis

  1. IAW

    To Tony:
    I do not know if Dr. Cannell posts these inquiries in “real time”. If he does, I do hope you, your friend and the patient pay close attention to the following statement made by Dr. Cannell. “Also, the husband (and patient) always has the option to interfere in the case.” If it was me I would order and have “overnighted” the 50,000 iu’s to me but in the meantime RUN to the store and get hopefully 5000’s and take 10 (total 50,000 iu per day). Get some magnesium too!
    Then decide if you really want to tell the doctor you are taking it or just take it. (My 19 year old daughter was in the hospital last year and we chose NOT to tell! I was not in the mood to try and battle the “ignorance” that I knew I would be up against at the time!)

  2. Rita and Misty

    To tell or NOT to tell your physician…always a dilemma for me…

    I think it depends on how strong you are in your knowledge regarding vitamin d…as well as your overall strength of personality and determination….

    For me, I would tell the physician with the hope of educating him or her…

    And, I would continue to take whatever amount I personally decided upon based on my own research, regardless of whatever conniption fit the physician may have on the matter of vitamin d.

    We each are responsible for our own health.

    (Obviously, this is only ME…and everyone must be comfortable in their own skin and with their own decisions.)

    Be well!
    Rita

  3. pab

    absolutely! take the vitamin D. Also, should be tested for celiac disease, she may not even have Crohns at all.

  4. Rebecca Oshiro

    I stopped taking oral vitamin D in April because I wanted to make vitamin D “the natural” way, through sun exposure. Even though I was getting at least three, thirty minute exposures of midday, full-body sun exposure, I became very sick a couple weeks ago. I increased my sunbathing to an hour per day to hopefully combat the infection. After a week of feeling terrible and being on the verge of going to the doctor, I decided to take 5,000 IU of vitamin D on top of my sunbathing and see what happened. Overnight the sinus drainage was cut in half. Two days later it had stopped. I know from long term monitoring of my D levels under various conditions that with sun exposure and UVB lights, my 25(OH)D levels range from 39-47 ng/mL. On 4,000 IU per day it is 60 ng/mL. I will never again let my level dip below 60, as this recent illness was a wake up call demonstrating that I was not only susceptible to becoming very ill with a vitamin D level in the 40’s, but unable to overcome the infection until my level was considerably higher, somewhere in the 50’s or 60’s. What amazes me is that if I had gone to the doctor, I probably would have been prescribed an antibiotic when the true cause of the prolonged infection was my weakened immunity from a lack of vitamin D.

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