Abstract
BACKGROUND: Knee osteoarthritis caused by endemic skeletal fluorosis is a complex and chronic systemic disease,which can cause the damage of surrounding bone and sclerotin of knee joint.
OBJECTIVE: To investigate the effect of total knee arthroplasty (TKA) in the treatment of knee osteoarthritis caused by endemic skeletal fluorosis.
METHODS: Nine patients suffered from knee osteoarthritis caused by skeletal fluorosis that diagnosed by local epidemiology,dental fluorosis,clinical and imaging from March 2010 to October 2011 and all the patients were treated with bilateral TKA. The clinical efficacy was evaluated according to the knee scoring system of United States Hospital for Special Surgery before arthroplasty and final follow-up after arthroplasty.
RESULTS AND CONCLUSION: Score results showed that 5 knees were excellent, 3 knees were good and 1 knee was fair after knee arthroplasty. All patients have been improved in pain, function and range of motion. TKA is an effective method for the treatment of knee osteoarthritis caused by skeletal fluorosis.
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Why did the ancient inhabitants of Palmyra suffer fluorosis?
The skeletal remains uncovered from the 2nd and 3rd century underground tombs of Palmyra, Syria, retain traces of arthritis and mottled enamel. A brown discoloration was also observed in the teeth. In order to clarify that these facts can be related to fluorosis, the teeth excavated from Tomb C and
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Skeletal fluorosis mimicking seronegative spondyloarthropathy: a deceptive presentation
Skeletal fluorosis is rarely recognized early and is amajor cause of morbidity.We report on a 40-year-old man with skeletal fluorosis mimicking seronegative spondyloarthropathy.
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Recovery from skeletal fluorosis (an enigmatic, American case)
A 52-year-old man presented with severe neck immobility and radiographic osteosclerosis. Elevated fluoride levels in serum, urine, and iliac crest bone revealed skeletal fluorosis. Nearly a decade of detailed follow-up documented considerable correction of the disorder after removal of the putative source of fluoride (toothpaste). INTRODUCTION: Skeletal fluorosis, a crippling bone
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Fluorosis in Aden
The cases to be described here occurred in the Aden Protectorate where for the last 12 years mass screening of the chest to exclude pulmonary tuberculosis has been carried out. The patients had all drunk the brackish water from the wells, and the analysis of the water from a well
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Rapid-onset diffuse skeletal fluorosis from inhalant abuse
Case: A thirty-year-old man presented with severely debilitating left hip pain and stiffness. Radiographs demonstrated diffuse osteosclerosis and heterotopic bone formation with near ankylosis of the left hip. The patient underwent successful joint-preserving surgery to restore hip range of motion. After disclosing a history of inhalant abuse, which was confirmed
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"Pre-Skeletal" Fluorosis
As demonstrated by the studies below, skeletal fluorosis may produce adverse symptoms, including arthritic pains, clinical osteoarthritis, gastrointestinal disturbances, and bone fragility, before the classic bone change of fluorosis (i.e., osteosclerosis in the spine and pelvis) is detectable by x-ray. Relying on x-rays, therefore, to diagnosis skeletal fluorosis will invariably fail to protect those individuals who are suffering from the pre-skeletal phase of the disease. Moreover, some individuals with clinical skeletal fluorosis will not develop an increase in bone density, let alone osteosclerosis, of the spine. Thus, relying on unusual increases in spinal bone density will under-detect the rate of skeletal fluoride poisoning in a population.
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Skeletal Fluorosis: The Misdiagnosis Problem
It is a virtual certainty that there are individuals in the general population unknowingly suffering from some form of skeletal fluorosis as a result of a doctor's failure to consider fluoride as a cause of their symptoms. Proof that this is the case can be found in the following case reports of skeletal fluorosis written by doctors in the U.S. and other western countries. As can be seen, a consistent feature of these reports is that fluorosis patients--even those with crippling skeletal fluorosis--are misdiagnosed for years by multiple teams of doctors who routinely fail to consider fluoride as a possible cause of their disease.
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Fluoride & Osteoarthritis
While the osteoarthritic effects that occurred from fluoride exposure were once considered to be limited to those with skeletal fluorosis, recent research shows that fluoride can cause osteoarthritis in the absence of traditionally defined fluorosis. Conventional methods used for detecting skeletal fluorosis, therefore, will fail to detect the full range of people suffering from fluoride-induced osteoarthritis.
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X-Ray Diagnosis of Skeletal Fluorosis
In 1937, Kaj Roholm published his seminal study Fluorine Intoxication in which he described three phases of bone changes that occur in skeletal fluorosis. (See below). These three phases, which are detectable by x-ray, have been widely used as a diagnostic guide for detecting the disease. They describe an osteosclerotic bone disease that develops first in the axial skeleton (the spine, pelvis, and ribs), and ultimately results in extensive calcification of ligaments and cartilage, as well as bony outgrowths such as osteophytes and exostoses. Subsequent research has found, however, that x-rays provide a very crude measure for diagnosing fluorosis since the disease can cause symptoms and effects (e.g., osteoarthritis) before, and in the absence of, radiologicaly detectable osteosclerosis in the spine.
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Variability in Radiographic Appearance of Skeletal Fluorosis
Osteosclerosis (dense bone) is the bone change typically associated with skeletal fluorosis, particularly in the axial skeleton (spine, pelvis, and ribs). Research shows, however, that skeletal fluorosis produces a spectrum of bone changes, including osteomalacia, osteoporosis, exostoses, changes resulting from secondary hyperparathyroidism, and combinations thereof. Although the reason for this radiographic variability is not yet fully understood, it is believed to relate to the dose of fluoride consumed, the individual's nutritional status, exposure to aluminum, genetic susceptibility, presence of kidney disease, and area of the skeleton examined.
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