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tuberculous arthritis

Five syndromes have been described. 1) spondylitis (Pott's disease) 2) peripheral arthritis 3) osteomyelitis 4) tenosynovitis 5) Poncet's disease Etiology: - Mycobacterium tuberculosis - reactivation tubercylosis - risk factors - travel to &/or origination from endemic area - immunosuppression Epidemiology: 1) bone & joint tuberculosis account for 10% of cases of extrapulmonary tuberculosis 2) 2% of new cases of tuberculosis involve the bone or joints Pathology: - caseating granulomas in bone biopsy or synovial biopsy Clinical manifestations: 1) 75% of patients with oligoarticular tuberculosis do not have pulmonary involvement at the time of diagnosis 2) slowly evolving, inflammatory monoarticular process involving a weight-bearing joint or the thoracic spine 3) fever & other systemic symptoms are uncommon Laboratory: 1) tuberculin skin testing is generally positive 2) aspiration of joint fluid a) acid fast stain b) mycobacterial cultures 3) bone biopsy required for Pott's disease 4) synovial biospy [1] 5) PCR for Mycobacterium tuberculosis DNA 6) elevated erythrocyte sedimentation rate is common 7) HIV testing Radiology: - chest X-ray is generally negative - involved joint may show non-specific erosions [1] Management: 1) initiate empiric 4 drug therapy based upon biopsy &/or PCR while awaiting results of culture 2) antituberculous therapy is generally curative without surgery

Specific

Poncet's disease tuberculous spondylitis; Pott's disease

General

infectious arthritis (septic arthritis) tuberculosis

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018
  2. Mariconda M, Cozzolino A, Attingenti P, Cozzolino F, Milano C. Osteoarticular tuberculosis in a developed country. J Infect. 2007 Apr;54(4):375-80. Epub 2006 Jul 24 PMID: 16860392
  3. Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR. Epidemiology of extrapulmonary tuberculosis in the United States, 1993-2006. Clin Infect Dis. 2009 Nov 1;49(9):1350-7 PMID: 19793000