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October 24, 2002

CDC: One in three suffer arthritis, joint problems

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ATLANTA (AP) -- Arthritis and other chronic joint problems are far more widespread than estimated just five years ago, affecting one in three U.S. adults, or 69.9 million people in all, the government said Thursday in the first comprehensive survey of the disease.

Health officials and advocates said the numbers -- and related health care costs -- are expected to continue to rise as the baby boom generation reaches old age.

The survey shocked even advocates for arthritis sufferers.

"We just think that's alarming in terms of the number," said Tino Mantella, president of the Arthritis Foundation.

The numbers were 63 percent higher than a 1997 estimate that said about one in five U.S. adults, or nearly 43 million in all, had arthritis and other chronic joint problems.

The new survey by the Centers for Disease Control and Prevention reflects, in part, a real increase in arthritis, connected to the aging of the baby boomers. But it also reflects a more thorough survey, the CDC said.

Previous estimates were much lower because many people do not tell doctors about their joint pain, and others do not consider their aches and pains to be arthritis, officials said. The latest survey employed more penetrating questions.

A total of 212,000 people from all 50 states were interviewed by telephone and asked if, in the previous year, they had pain, stiffness or swelling around a joint for at least a month. About a third of those with arthritis-like symptoms said they had not consulted a doctor about their symptoms.

"There are many people with chronic joint symptoms who don't see a doctor," said Dr. Chad Helmick of the CDC's arthritis program. The latest survey "is a better way of capturing people who have always been out there with arthritis or different symptoms."

The arthritis level ranged from 17.8 percent of adults in Hawaii to 42.6 percent of adults in West Virginia. States in the central and northwestern parts of the country had the highest rates.

Last year, arthritis patients cost the country about $80 billion in medical care costs and lost work, health officials said.

People can reduce their risk of arthritis through exercise, weight management and a healthy diet.

"The public has very little understanding about arthritis," said Dr. John Klippel, medical director for the Arthritis Foundation. "Many people associate arthritis with the process of aging, they assume aches and pains are an inevitable part of aging when in fact it is not a natural part of aging."

The survey confirmed previous studies that indicated arthritis tends to rise with age and that it is more common in women. In addition, arthritis is more common in those who are overweight or physically inactive.

Fluoride & Arthritis:


"Although skeletal fluorosis has been studied intensely in other countries for more than 40 years, virtually no research has been done in the U.S. to determine how many people are afflicted with the earlier stages of the disease, particularly the preclinical stages. Because some of the clinical symptoms mimic arthritis, the first two clinical phases of skeletal fluorosis could be easily misdiagnosed. Skeletal fluorosis is not even discussed in most medical texts under the effects of fluoride; indeed, a number of texts say the condition is almost nonexistent in the U.S. Even if a doctor is aware of the disease, the early stages are difficult to diagnose. " - Hileman B. (1988). Fluoridation of water.Questions about health risks and benefits remain after more than 40 years. Chemical and Engineering News. August 1, 1988, 26-42.

In the earliest 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." - Singh A, et al. (1963). Endemic fluorosis. Epidemiological, clinical and biochemical study of chronic fluoride intoxication in Punjab. Medicine. 42: 229-246.

"[E]xtensive research from India has revealed severe arthritic changes and crippling neurological complications even where the fluoride concentration in water naturally is as low as 1.5 ppm...Even though extensive bone deformities may not be found on a large scale from fluoride in water at the 1 ppm concentration, some of the early signs of the disease, such as calcifications of ligaments, joint capsules, and muscle attachments, are likely to occur. Indeed these conditions are characteristic of osteoarthritis, in which the formation of microcrystals of apatite (known to be promoted by fluoride) has now been clearly demonstrated. Among the elderly, arthritis of the spine is an especially common ailment that is customarily attributed to 'aging.' Since fluoride retention in bones increases as a person grows older, how can we disregard the possibility that this 'old age' disease might be linked with fluoride intake? For example, Pinet and Pinet described in detail X-ray changes encountered in skeletal fluorosis in North Africa that are in every respect identical with those present in the arthritic spine of the elderly elsewhere." - Waldbott GL, Burgstahler AW, and McKinney HL. (1978). Fluoridation: The Great Dilemma. Coronado Press, Inc., Lawrence, Kansas.

"Whereas dental fluorosis is easily recognized, the incipient skeletal involvement is not clinically obvious until the disease has advanced to the state of crippling...[The early cases of the disease] are usually young adults whose only complaints are vague pains most frequently in the small joints of the hands and feet, the joints of knee and spine. Such cases are common in an endemic area. They are misdiagnosed as rheumatoid arthritis or ankylosing spondylitis." - Jolly SS. (1968). An epidemiological, clinical and biochemical study of endemic, dental and skeletal fluorosis in Punjab. Fluoride. 1(2): 65-75.

"At higher levels of ingestion - from 2 to 8 mg daily, skeletal fluorosis may arise ... Whereas dental fluorosis is easily recognized, the skeletal involvement is not clinically obvious until the advanced stage of crippling fluorosis ... early cases may be misdiagnosed as rheumatoid or osteo arthritis." - World Health Organization. (1970). Fluorides and Human Health. pp 32, 239-240.

"In light cases of fluorosis, the bone changes are often associated with nonspecific joint and muscle pains..." - Grandjean P. (1982). Occupational fluorosis through 50 years: clinical and epidemiological experiences. Am J Ind Med. 3(2):227-36.

"The ligamentous calcification [of skeletal fluorosis] is often periarticular and shows as osteoarthritis of the spine and hip joints as well as of the sacro-iliac joints." - Kumar SP, Harper RA. (1963). Fluorosis in Aden. British Journal of Radiology. 36: 497-502.

"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." - 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." - Teotia SPS, et al. (1976). Symposium on the Non-Skeletal Phase of Chronic Fluorosis: The Joints. Fluoride 9(1): 19-24. (See paper)

Results from Clinical Trials

"Results from several large (fluoride clinical trials) indicate that significant side effects attributable to treatment occur in about one-third to one-half of patients. Symptoms have been of two types--periarticular and gastrointestinal. Periarticular symptoms have consisted of periarticular pain, and occasionally, tenderness about the large joints of the lower extremities and a painful plantar syndrome." - Riggs BL. (1984). Treatment of osteoporosis with sodium fluoride: An appraisal. Bone and Mineral Research. 2: 366-393.

"Osteoarticular pains in the lower extremities often combined with ankle swelling represent the major problem of NaF treatment." - Dambacher MA, et al. (1978). Long term effects of sodium fluoride in osteoporosis. In: Fluoride and Bone; Proceedings of the Second Symposium CEMO, Nyon, Switzerland, Oct. 9-12, 1977. Bern Switzerland, Hans Huber Publishers.

"In 47% of the treated patients, osteoarticular side effects were observed." - Dambacher MA, et al. (1986). Long-term fluoride therapy of postmenopausal osteoporosis. Bone. 7: 199-205.

"Fractures and exacerbation of arthrosis were more frequent in the fluoride group." - Inkovaara J, et al. (1975). Phophylactic fluoride treatment and aged bones. British Medical Journal. 3: 73-74.

"This report documents the repeated exacerbation of rheumatoid arthritis on three occasions after the initiation of sodium fluoride therapy...We suggest that sodium fluoride should be used cautiously in patients with rheumatoid arthritis." - Duell PB, Chestnut CH. (1991). Exacerbation of rheumatoid arthritis by sodium fluoride treatment of osteoporosis. Archives of Internal Medicine. 151(4):783-4.

"The use of fluoride in the prophylaxis or treatment of osteoporosis seems highly questionable for the following reasons: (a) the therapeutic window is very narrow, (b) 15%-37% of patients do not respond to fluoride, (c) there are frequent gastrointestinal disturbances and arthralgias, and especially because (d) patients receiving fluoride have experienced more fractures, especially nonvertebral and hip fractures, than control patients." - Inkovaara JA. (1991). Is fluoride treatment justified today? Calcified Tissue International. 49 Suppl:S68-9.

In osteoporosis treatment "there have been serious concerns raised about the safety of sodium fluoride, which has a tendency to cause significant upper gastrointestinal side-effects, arthritis, fascitis, and a more recently described acute lower extremity pain syndrome." - Hodsman AB, Drost DJ. (1989). The response of vertebral bone mineral density during the treatment of osteoporosis with sodium fluoride. Journal of Clinical Endocrinology and Metabolism. 69(5):932-8.

See Second Look's Fluoride Bibliography