tuberculous arthritis
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Introduction
Five syndromes have been described.
Etiology
- Mycobacterium tuberculosis
- reactivation tubercylosis
- risk factors
- travel to &/or origination from endemic area
- immunosuppression
Epidemiology
- bone & joint tuberculosis account for 10% of cases of extrapulmonary tuberculosis
- 2% of new cases of tuberculosis involve the bone or joints
Pathology
- caseating granulomas in bone biopsy or synovial biopsy
Clinical manifestations
- 75% of patients with oligoarticular tuberculosis do not have pulmonary involvement at the time of diagnosis
- slowly evolving, inflammatory monoarticular process involving a weight-bearing joint or the thoracic spine
- fever & other systemic symptoms are uncommon
Laboratory
- tuberculin skin testing is generally positive
- aspiration of joint fluid
- bone biopsy required for Pott's disease
- synovial biospy[1]
- PCR for Mycobacterium tuberculosis DNA
- elevated erythrocyte sedimentation rate is common
- HIV testing
Radiology
- chest X-ray is generally negative
- involved joint may show non-specific erosions[1]
Management
- initiate empiric 4 drug therapy based upon biopsy &/or PCR while awaiting results of culture
- antituberculous therapy is generally curative without surgery
More general terms
More specific terms
References
- ↑ 1.0 1.1 1.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17, 18. American College of Physicians, Philadelphia 1998, 2015, 2018
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/16860392
- ↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/19793000