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