Patient: My 14 year old son is quite active and complained of knee problems last year so we found out that he had bone contusions in his knee from playing baseball and that his vitamin d was 18. He went on vitamin d therapy for a couple of months, the knee pain left him quickly and his new vitamin d level was normal. However, during this time he had an elevated ANA that couldn’t be explained. A year later, he again complained of knee problems and his vitamin d level was 27. He also had a positive ANA, but has no other symptoms. His knee seemed to be prone to his flat feet and this checked out with a podiatrist. Again, knee pain has left him and he is going back on Vitamin D therapy this week to get those levels back to normal. We are still puzzled about the ANA. Can you offer some thoughts on whether or not the Vitamin D deficiency is causing positive ANA or if the combination of ANA and D is symptomatic of another disorder? Also, this boy is quite healthy and very strong. However, he is short in stature; we believe this is genetic from both parents. We just want to make sure that we are not losing valuable growth time because he is low in D. Any insights would be greatly appreciated. Thanks.
Doctor: The diagnosis in this case could be varied . From the information you have given me it could be due to vit d deficiency, or considering a positive ANA it could be come rheumatological condition like arthritis which needs to be investigated further. You need to see you family physician for a indepth history adn physical examination and more tests so that there is a clearer picture. All the best.