II. Definition
- Arthritis secondary to Mycobacterium tuberculosis
III. Epidemiology
- Occurs in 2% of Tuberculosis patients
- Represents 35% of Extrapulmonary Tuberculosis
IV. Findings: Distribution
- Spinal Tuberculosis (Pott's Disease)
- Spine is most common site of TuberculosisArthritis
- Thoracic Spine most commonly involved
- Associated with paraspinous abscess
- Destroys anterior Vertebral body and adjacent disc
- Results in anterior wedging
- Forms prominence of spine known as Gibbus
- May compress central cord
- Articular Tuberculosis
- Monoarticular Arthritis of weight bearing joints (Knee is most common joint involved, after spine)
- Presents with insidious monoarticular pain, swelling
- May form superficial abscesses and drain to skin
- Poncet's Disease (rare)
- Acute sterile Polyarthritis
- Associated with visceral involvement
- Tuberculous Osteomyelitis
- May involve any bone
V. Signs
- Doughy synovitis on joint palpation
- Develops very slowly (months to years)
VI. Labs
-
Tuberculin Skin Test (Purified Protein Derivative)
- Positive in most cases
-
Synovial Fluid Exam
- See Septic Arthritis
VII. Imaging: Chest XRay
- Pulmonary involvement in only 50% of Tb Arthritis
VIII. Diagnosis
-
Arthrocentesis with Mycobacterium tuberculosis culture
- Test Sensitivity: 80%
- Synovial biopsy
IX. Management
- See Extrapulmonary Tuberculosis
- See Tuberculosis Management
- Consult infectious disease
- Follow Tuberculosis Management guidelines and treat for 6 to 9 months
- Treatment starts with typically 4 drug regimen until susceptibilities available
- Regimens are similar to pulmonary Tuberculosis regimens, and typically contain Rifampin
X. References
- (2021) Bone and Joint Tuberculosis, Uptodate, accessed on IOS, 12/16/2021
- (2021) Sanford Guide, accessed on IOS, 12/16/2021
- Watts (1996) J Bone Joint Surg Am 78:288-98 [PubMed]