Rheumatoid arthritis (RA) is a condition marked by inflammation of the joints and is estimated to affect over 2 million Americans. It primarily affects women and generally develops between the ages of 30 and 50.

As reported below, the symptoms of skeletal fluorosis can closely resemble RA, and thus individuals with fluorosis can “easily be mistaken” as having RA. (Kumar 2011). In addition, clinical research on fluoride-treated osteoporosis patients (22 mg/day) has found that fluoride exposure can exacerbate pre-existing RA. (Duell 1991).

Although researchers have yet to examine whether lower doses of fluoride can exacerbate RA, recent research has found that the levels of fluoride found in the blood of the general population (19-57 ppb) are sufficient to effect an enzyme (15-lipoxygenase, also known as 15-LOX) implicated in the inflammatory process. As noted by the authors: “This study indicated that even in small concentrations, fluorides changes the amounts and activity of 15 LOX-1 and -2 enzymes taking part in the development of inflammatory process.” (Gutowska 2012). This is a significant finding because 15-LOX enzymes “are important in the rheumatoid arthritis (RA) inflammatory process.”  (Gheorghe 2009).

References:

• Duell PB, Chesnut CH. (1991). Exacerbation of rheumatoid arthritis by sodium fluoride treatment of osteoporosis. Archives of Internal Medicine 151:783-4.
• Gheorghe KR, et al. (2009). Expression of 5-lipoxygenase and 15-lipoxygenase in rheumatoid arthritis synovium and effects of intraarticular glucocorticoids. Arthritis Research & Therapy 11(3):R83.
• Gutowskaa I, et al. (2012). Fluoride in low concentration modifies expression and activity of 15 lipoxygenase in human PBMC differentiated monocyte/macrophage. Toxicology 295:23-30.
• Kumar S, et al. (2011). Skeletal fluorosis mimicking seronegative spondyloarthropathy: a deceptive presentation. Tropical Doctor 41:247-48.

High Fluoride Exposure Can Exacerbate Pre-Existing Rheumatoid Arthritis:

“This case documents the repeated aggravation of rheumatoid arthritis following sodium fluoride treatment (7 mg of fluoride, 3 times a day). Although these data do not conclusively prove that sodium fluoride caused the worsening of our patient’s rheumatoid arthritis, the reproducibility of this effect on three occasions suggests that there is a high probability that sodium fluoride has a causative role in this previously unreported complication. Moreover, there are experimental data that suggest that one might expect sodium fluoride to increase the activity of rheumatoid arthritis.”
SOURCE: Duell PB, Chesnut CH. (1991). Exacerbation of rheumatoid arthritis by sodium fluoride treatment of osteoporosis. Archives of Internal Medicine 151:783-4. [See study]

Symptoms of Skeletal Fluorosis Resemble Rheumatoid Arthritis

“The early stages of the disease may essentially be asymptomatic or present as subtle changes such as pain in the neck or back with rigidity, joint pains in multiple joints and paraesthesias in the limbs. This can easily be mistaken for other conditions such as rheumatoid arthritis, osteoarthritis or seronegative spondyloarthropathy.”
SOURCE: Kumar S, et al. (2011). Skeletal fluorosis mimicking seronegative spondyloarthropathy: a deceptive presentation. Tropical Doctor 41:247-48.

“Analysis of workers’ complaints showed no specific pain or other symptom that we could refer only to fluorosis…The only characteristic feature would be multiple-joint involvement in the case of fluorosis. This would differentitate fluorosis from monoarticular osteoarthritis (OA), but unfortunately not from multiple-joint osteoarthritis or rheumatoid arthritis (RA).”
SOURCE: Czerwinski E, et al. (1988). Bone and joint pathology in fluoride-exposed workers. Archives of Environmental Health 43: 340-343.

“[I]t is postulated that fluoride activates the calcification of cartilage…Thus it would be interesting to investigate the effect of fluoride on the evolution of joint alterations in rheumatoid arthritis and osteoarthrosis.”
SOURCE: Bang S, et al. (1985). Distribution of fluoride in calcified cartilage of a fluoride-treated osteoporotic patient. Bone 6: 207-210.

“Early bone fluorosis is not clinically obvious; often the only complaints of young adults are vague pains in the small joints of the hands, feet, and lower back. Such cases may be misdiagnosed as rheumatoid arthritis or ankylosing spondylitis.”
SOURCE: Smith GE. (1985). Repetitive Strain Injury, or Incipient Skeletal Fluorosis? (Letter.) New Zealand Medical Journal 98:328..

“In early stages, fluorosis is usually associated only with stiffness, backache, and joint pains which may suggest the diagnosis of rheumatism, rheumatoid arthritis, ankylosing spondylitis and osteomalacia. At this stage the radiological findings of skeletal fluorosis may not be evident and therefore most of these cases are either misdiagnosed for other kinds of arthritis or the patients are treated symptomatically for pains of undetermined diagnosis (PUD). The majority of our patients had received treatment for rheumatoid arthritis and ankylosing spondylitis before they came under our observation.”
SOURCE: Teotia SPS, et al. (1976). Symposium on the Non-Skeletal Phase of Chronic Fluorosis: The Joints. Fluoride 9(1): 19-24.

“Whereas dental fluorosis is easily recognized, the skeletal involvement is not clinically obvious until the advanced stage of crippling fluorosis… Such early cases are usually in young adults whose only complaints are vague pains noted most frequently in the small joints of the hands and feet, in the knee joints and in the joints of the spine. These cases are frequent in the endemic area and may be misdiagnosed as rheumatoid or osteo arthritis.”
SOURCE: Singh A, Jolly SS. (1970). Chronic toxic effects on the skeletal system. In: Fluorides and Human Health. World Health Organization. pp. 238-249.

In the early stages of skeletal fluorosis, the “only complaints are vague pains noted most frequently in the small joints of hands and feet, the knee joints and those of the spine. Such cases are frequent in the endemic area and may be misdiagnosed as rheumatoid or osteoarthritis. Such symptoms may be present prior to the development of definite radiological signs. A study of the incidence of rheumatic disorders in areas where fluoridation has been in progress for a number of years would be of interest.”
SOURCE: Singh A, et al. (1963). Endemic fluorosis. Epidemiological, clinical and biochemical study of chronic fluoride intoxication in Punjab. Medicine 42: 229-246

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