Biography
Biography: R Aneja
Abstract
Introduction: Skeletal fluorosis is endemic in many parts of the world but the reports of skeletal fluorosis are scarce from Arabian Peninsula. Case: We report a case of an 82 years old male who reported in our clinic with joint and bone pains for several months. There were no features of any inflammatory joint disease. He admitted to mechanical back pain after asking leading questions. On examination he had bony swelling in bilateral PIP and DIP joints. He had tenderness over multiple soft tissue areas and his spinal range of motion was restricted. There was no history of fracture. His X-ray cervical spine showed calcification of anterior and interspinous ligaments as well as calcification of posterior longitudinal ligament. His DEXA scan was done as part of clinical workup to look for osteoporosis. The DEXA scan revealed very high bone density with a T-score at Lumbar spine of +7.3. X ray forearm showed calcification of interosseous membrane. His urine and serum sample was evaluated for fluoride levels. The serum fluoride level was 103 microgram/L (normal<30). This patient was diagnosed as chronic skeletal fluorosis. The source of excess fluoride intake was not very evident. Patient had been drinking well water in his village in Yemen 7 year ago. For past few years he has been living in UAE and is drinking tap water. Intermittently he travels to and stays in Saudi Arabia. He has never used fluoridated toothpaste. There is no effective therapeutic agent to treat fluorosis. The main treatment modalilty is to eliminate fluoride intake by provision of safe drinking water and nutritional supplementation with calcium and vitamin D. Conclusion: Fluorosis has been described as a consequence of exposure to high fluoride levels in natural ground water in endemic areas. There are now case reports of patients having fluoride toxicity as a result of excessive tea drinking, use of fluoridated toothpaste and industrial exposure in non-endemic areas as well. It is important to be aware of this condition as it can mimic rheumatological conditions like, Ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis.