Skeletal Tuberculosis

Aka: Skeletal Tuberculosis, Tuberculous Arthritis, Pott's Disease, Poncet's Disease, Spinal Tuberculosis, Articular Tuberculosis, Tuberculous Osteomyelitis, Gibbus

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II. Definition

  1. Arthritis secondary to Mycobacterium tuberculosis

III. Epidemiology

  1. Occurs in 2% of Tuberculosis patients
    1. Represents 35% of Extrapulmonary Tuberculosis

IV. Findings: Distribution

  1. Spinal Tuberculosis (Pott's Disease)
    1. Spine is most common site of TuberculosisArthritis
    2. Thoracic Spine most commonly involved
    3. Associated with paraspinous abscess
    4. Destroys anterior Vertebral body and adjacent disc
      1. Results in anterior wedging
      2. Forms prominence of spine known as Gibbus
      3. May compress central cord
  2. Articular Tuberculosis
    1. Monoarticular Arthritis of weight bearing joints (Knee is most common joint involved, after spine)
    2. Presents with insidious monoarticular pain, swelling
    3. May form superficial abscesses and drain to skin
  3. Poncet's Disease (rare)
    1. Acute sterile Polyarthritis
    2. Associated with visceral involvement
  4. Tuberculous Osteomyelitis
    1. May involve any bone

V. Signs

  1. Doughy synovitis on joint palpation
  2. Develops very slowly (months to years)

VI. Labs

  1. Tuberculin Skin Test (Purified Protein Derivative)
    1. Positive in most cases
  2. Synovial Fluid Exam
    1. See Septic Arthritis

VII. Imaging: Chest XRay

  1. Pulmonary involvement in only 50% of Tb Arthritis

VIII. Diagnosis

  1. Arthrocentesis with Mycobacterium tuberculosis culture
    1. Test Sensitivity: 80%
  2. Synovial biopsy

IX. Management

  1. See Extrapulmonary Tuberculosis
  2. See Tuberculosis Management
  3. Consult infectious disease
  4. Follow Tuberculosis Management guidelines and treat for 6 to 9 months
    1. Treatment starts with typically 4 drug regimen until susceptibilities available
    2. Regimens are similar to pulmonary Tuberculosis regimens, and typically contain Rifampin

X. References

  1. (2021) Bone and Joint Tuberculosis, Uptodate, accessed on IOS, 12/16/2021
  2. (2021) Sanford Guide, accessed on IOS, 12/16/2021
  3. Watts (1996) J Bone Joint Surg Am 78:288-98 [PubMed]

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