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calcium and a definite osteoporosis in x-ray spine and ends of long bones prove the diagnosis.

Treatment

Androgenic steroids like Decadurabolin 25 mg once in 3 weeks, help but pain relief is not immediate. Durabolin 10 mg per day for four days consecutively, then once a week, later once a fortnight helps in immediate relief of pain. These increase new bone formation. Calcium has not been of proven value.

Degenerative arthritis

The commonly affected joints are the spine, knees and ankles which are the weight bearing joints. Presenile onset occurs in association with Diabetes mellitus and syphilis. Trauma plays an important role aetiologically e.g., football players in whom there is repeated minimal trauma with new bone formation.

There is a superficial rupture of the cartilage and ulceration of the superficial layer of the cartilage. New bone formation leads on to osteophytes which cause erosion of the synovial membrane. Hence movements are restricted and abnormal movements occur. A vicious circle thus ensues ultimately leading to immobile joints. Synovial effusion and thickening are minimal.

Clinical features

Pain is constant, initially during squatting, defaecating etc., action pain leads on to static pain in later stages. Bending the knee even upto 300 causes pain. One knee joint is affected first, then the next or even simultaneously. The lumbosacral spine is frequently involved. Osteophytes compress the radicles and lead on to a compression radiculopathy. They also interfere with the circulation thus causing progressive paraparesis and other neurological deficits. Painful limitation of movements and occasional effusions are other characteristics.

X-ray of the involved joints shows rarefaction of bone, distortion of articular surfaces, osteoporosis and loose bodies. ESR is normal.

Treatment

The analgesic group of drugs (to be dealt with in detail ill the treatment of Rheumatoid arthritis) are administered. However remission is incomplete. The various methods employed in therapy are: (i) Rest to the joints (ii) Intra articular hydro-cortisone (iii) Short wave diathermy (iv) traction and (v) superficial x-ray irradiation. A combination of Indomethacin and ultra short wave diathermy is quite effective. Intra articular cortisone with adequate sterilisation measures is of immense help.

Rheumatoid arthritis

Peripheral joints along with the knee and ankle joints are most affected and centri-fugally too. Symmetrical involvement is the rule, though asymmetry is not uncommon. There is swelling of all peripheral joints excluding the terminal interphalangeal joints and the temporo-mandibular joints are affected. Rheumatoid arthritis in the young manifests as 3 types, viz. (i) senile rheumatoid arthritis-like type (ii) ankylosing

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