FLUOROSIS

 A 61 YEARS MALE HAILING FROM RAEBARELI DISTRICT OF U.P., CAME WITH COMPLAINTS OF STIFFNESS OF JOINT WITH RESTRICTED JOINT MOVEMENTS, DIFFICULTY IN WALKING, PAIN IN BACK SINCE 2-3 YEARS AND PAIN IN MULTIPLE JOINTS…..

Chronic fluorosis is a systemic disease
High doses of fluoride leads to bioaccumulation in the body, especially hard tissues such as bones and teeth, and primarily causes significant changes.
Metabolic, structural, and functional damage to the nervous system, kidneys, liver, cardiovascular system and reproductive system.
As Fluoride is a cumulative toxin, its accumulation destroys the processes of bone formation and resorption and also affects collagen and non collagen formation causing changes in collagen cross-linking.


Fluorine is a double edge sword. Inadequate intake is associated with “dental caries” whereas excess intake with “dental and skeletal fluorosis”.
Level > 1.5 ppm : dental fluorosis(mottling).
Level 3.0 – 6.0 ppm : skeletal fluorosis.
Level > 10.0 ppm : crippling fluorosis.
Recommended level in drinking water in India: 0.5-0.8 mg/litre(ppm).



Musculoskeletal fluorosis involves all the bones from head to toe.
In the skull, calcifications of petro-clinoid ligaments, diaphragma sella, ligamentum nuchae etc., are observed.
In the calvarium, diploic thickening prominent occiput and frontal ridges are seen.
In adults, diffuse sclerosis of the axial skeleton with enthesopathy, calcification of the paravertebral ligaments and ligamentum flava.
In the cervical spine, the anterior longitudinal ligament may have flowing hyperostosis simulating diffuse idiopathic skeletal hyperostosis (DISH)


In the thoracic cage, the ribs may show diffuse sclerosis with saw tooth like appearance.
In the pelvis, ligamentous calcification is seen in obturator membrane, sacrospinous, sacrotuberous and Para articular ligaments and lumbosacral ligament.
Bony excrescencies simulating exostosis are noted in the iliac crest.
Ischial tuberosities and bony protuberances. The ischial changes show simulating “whiskering” noted in ankylosing spondylitis


The appendicular skeleton shows variable changes depending upon the stage of fluorosis.
Calcification of the interosseous membrane of the forearm is classical.
Sclerotic changes and periosteal proliferation in the bones of the forearm and hand are common and periosteal proliferation may simulate exostoses.
Often, degenerative changes are noted in the knee joints with calcification of Para articular structures and tendons resulting in deformities.



COMPLICATIONS:

DEGENERATIVE ARTHRITIS
DEGENERATIVE SPONDYLOSIS
PATHOLOGICAL FRACTURES
NEUROLOGICAL ABNORMALITIES
SECONDARY HYPERPARATHYROIDISM.