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as exfoliative dermatitis and renal damage are not met with in practice. Agra-nulocytosis has been reported.

To start with, in a case of Rheumatoid arthritis antibiotics are administered for 5-6 days to combat any infection. Then phenylbutazone 200 mgms twice a day along with antacids or Indomethacin 25 mgms to 50 mgms thrice daily is administered. Reduced salt intake is advised during administration of butazolidine. If butazoli- dones are not acceptable to the patient, Ibuprofen is administered. Physiotherapy prevents atrophy of muscles. Steroid therapy is to be deferred due to complications as rarefaction and proximal myopathy.

Other joint disorders

These are rather uncommon. Gout, collagen disorders as lupus erythematosus, colitis, tuberculosis, malignancy, polymyositis may cause joint diseases. Penicillin, Procainamide and dilantin cause joint disorders too.

Cervical spondylosis

This is a degenerative arthritis of the lower cervical spines. It is a disease of old age and frequently occurs in weight lifters, in lorry drivers and those who practice yogasana. Sudden jolting of the body and neck causes strain and minor trauma leads on to oedema of the cartilage. Cartilage dehydration is also seen. There occurs alteration in the electrolyte content of the cartilage. Mucopolysaccharide formation is less. Annulus fibrosus gets ruptured and the soft nucleus pulposus protrudes posteriorly. The fibroblastic reaction of the dura results in a fibrous bend which interferes with the circulation. Or Ligamentum denticulatum is fibrosed, and movements of the spine do not produce movements of the spinal cord and hence pain. Fibrosis of the perineurium causes radiculopathy. Cervical spondylosis can present with (i) radicular pain with atropy of muscles but with power retained till the last (ii) progressive compressive paraplegia and (iii) acute over chronic picture when a symptomatic cervical spondylosis is complicated by trauma. A low plantar extensor is significant. Myelography proves the diagnosis. Some develop symptoms of vertebro-basilar insufficiency on turning the neck. Laminectomy and removal of the damaged cartilage is the treatment of choice.

(i) Low backache

It is common in osteoporosis and degenerative arthritis involving lumber spines. In women, pelvic pathology has to be excluded. If pain occurs during rest, a non- osteoporotic and a non-degenerative arthritic joint disorder is thought of. Pain is action oriented (as assuming erect posture) in osteoporosis. Pain during specific movements as bending, lifting weight and when associated with neurologic deficits as numbness of feet, pain radiating over the back and clawfoot is due to degenerative arthritis.

(ii) Pain in the knee and or ankle

Degenerative arthritis is the commonest cause. Particular movements as squatting cause pain. There is crepitus and restriction of movements. Obesity is often associated. Degenerative arthritis picks up certain joints. When knee and ankle joint pain is

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