India - Could apply here as well

Joint pain? It could be fluorosis
Meenakshi Kumar
[ 17 Dec, 2006 0034hrs ISTTIMES NEWS NETWORK ]
NEW DELHI: The next time you suffer from a persistent backache or an irritating stiff joint, don't attribute it to long hours spent at the computer. It could well be the result of fluorosis, a disease thought to affect people in rural India with no access to safe drinking water. It's time to include it in the long list of urban lifestyle diseases.
While fluoride-rich water is perceived as a major cause for fluorosis, in reality, 50% of fluoride entry into the body is through food. Whether it's a plate of chaat-papri, liberally sprinkled with black salt, canned fruit juices, black tea, masala powders or Hajmola tablets—all are equally responsible for increasing fluoride content in the body. Of course, regular consumption over a sustained period and the body's immune system determine how badly the fluoride affects the system.
"Patients come to me with complaints of back-ache, joint pains, fatigue and low energy levels. When I test their drinking water, it's perfect. But on testing their blood and urine samples, I find high fluoride content. Further examination reveals consumption of food rich in fluoride," says Dr A K Susheela, executive director, Fluorosis Research and Rural Development Foundation (FRRDF). Since its setting up in 1997, number of urban patients, she says, has doubled.
A recent UNICEF study conducted in smaller towns and rural areas revealed that 66 million are afflicted by fluorosis in India. Out of this, nearly 6 million are children between 6-14 years. The disease is widespread—19 states and 203 districts are affected —but efforts to prevent it are negligible. Unfortunately, no study has been conducted in cities on the numbers affected through food.
"It's necessary to first diagnose the disease. But no hospital is interested in buying the testing equipment. It costs only Rs one lakh. Is that too much for any hospital?" asks Susheela.
Till two years back, Bijoy De, an MNC executive, suffered from fluorosis symptoms—extreme fatigue, constant back and joint pains. When he visited Susheela, his haemoglobin level was 11. "I travel constantly and had little control over what I ate. On the advice of my doctor, I changed my food habits. Within 3-4 months, my haemoglobin level shot up to 13."
Similarly, Kanpur-based Ratish Bajpai was constantly fatigued and had regular back pain. On testing, the blood serum level was eight times above normal, while the fluoride level in urine was 20 times higher. " I had no idea about fluorosis. I vaguely knew it was something to do with water," he says.
And that's the level of awareness of most urban Indians—thanks to lack of knowledge among doctors and unavailability of fluorosis testing centres. Only two centres in the country, AIIMS and FRRDF, are equipped to test fluorosis. "As most doctors aren't trained for the disease, it goes largely undiagnosed or misdiagnosed," says Dr V B Bhasin, senior orthopaedic surgeon, Gangaram Hospital. In fact, many end up being treated for arthritis as the symptoms for both diseases are the same. In the past few years, Bhasin has had patients complaining of stiff joints and backaches.
When no other treatment works, he sends them for fluoride testing and most end up being positive. Affirms Dr P K Dave, chairman, Rockland Hospital, and a senior orthopaedic doctor, "In most cases, complaints of back pain have been traced to a high fluoride content in the body."
Interestingly, fluorosis manifests itself slowly. The good news is that it can be easily prevented in the early stages. However, in the advanced stage, called skeletal fluorosis—when the vertebrae partially fuses and moving joints becomes difficult— there's no cure.
"That's why," suggests Susheela, "it's important not to ignore joint pains and backaches. It's advisable to do a fluoride test whenever a backache or joint pain persists."
Thankfully, awareness levels are rising, though slowly.