Rheum

Skeletal Tuberculosis

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

  • Definition
  • Epidemiology
  1. Represents 35% of Extrapulmonary Tuberculosis
  • Distribution
  1. Spinal Tuberculosis (Pott's Disease)
    1. Thoracic Spine most commonly involved
    2. Associated with paraspinous abscess
    3. 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 (most common involvement)
    1. Monoarticular Arthritis of weight bearing joints
    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
  • Signs
  1. Doughy synovitis on joint palpation
  1. Pulmonary involvement in only 50% of Tb Arthritis
  • Diagnosis
  1. Arthrocentesis with Mycobacterium tuberculosis culture
    1. Test Sensitivity: 80%
  2. Synovial biopsy
  • Management
  1. See Extrapulmonary Tuberculosis
  2. See Tuberculosis Management
  3. Four drug regimen
    1. Isoniazid for 10 to 24 months
    2. Rifampin for 10 to 24 months
    3. Pyrazinamide for 2 months
    4. Ethambutol until Tuberculosis sensitivity established
    5. Atypical Mycobacteria require fifth drug added
      1. Azithromycin or
      2. Clarithromycin