A recent report in the Lok Sabha secretariat revealed that groundwater in a number of districts in Delhi contains a high level of fluoride, arsenic, and nitrate affecting the health of Delhiites. With one-third of groundwater in Delhi and the NCR containing an excessive concentration of fluoride, an increasing number of people are getting afflicted with arthritis and osteoarthritis, a rheumatic condition that affects joints and worsens with growing age.
“In India, the most common cause of fluorosis is high-fluoride well water derived from borewells dug deep into the earth. High concentration of fluoride in groundwater beyond the permissible limit of 1.5 mg/L is a major health problem in India. Nearly 90 per cent of the rural population of the country uses groundwater for drinking and domestic purposes and due to excess fluoride in groundwater, a huge chunk of the rural population is threatened with health hazards triggered by fluorosis,” said Dr Raju Vaishya, President, Indian Cartilage Society and Arthritis Care.
According to medical studies, skeletal fluorosis occurs when the fluoride concentration in water exceeds one part per million (ppm). Radiologically detectable skeletal fluorosis occurs in populations with typical exposures of 8 mg/day.
“Fluoride can cause chronic joint pain prior to causing x-ray-detectable fluorosis. Thus, for some individuals, the doses that can cause arthritic pain will be less than the 6 to 8 mg/day that causes radiologically detectable bone changes. While the advanced stages produce extreme, visibly crippling, effects on the skeleton, the earlier stages are less obvious, and extremely difficult to diagnose. There are three forms of fluoride poisoning or fluorosis. These are dental fluorosis, non-skeletal fluorosis, and skeletal fluorosis. Among individuals with skeletal fluorosis, the fluoride-induced changes to the bone, joints, and spine can cause widespread joint pain, arthritis and osteoarthritis,” said Vaishya.
A common finding among researchers investigating fluorosis is that the early stages are marked by symptoms (stiff and painful joints) which are frequently difficult to differentiate from various types of arthritis.