In medicine, early detection of the disease and treatment are key factors in successful management of the disease. If osteoarticular tuberculosis is diagnosed and treated at an early stage, the large majority of patients are expected to achieve healing with near normal function.
The mainstay of treatment is multidrug antitubercular chemotherapy and
- Rest
- Traction or splint [whenever required]
- Active or assisted exercises of the involved joint throughout the period of healing
An initial period of rest is to be followed by supervised gradual mobilization. The goals of antitubercular treatment are to
- Contain and eradicate the infection
- Relieve pain
- Preserve and restore bone and joint function
- Preserve and restore neurological function (In cases of spine)
Initial treatment is given under supervision and patient is hospitalized for that. This is done to take care of the affected part by traction or splint and to train the patient for modified self care at home.
For example in cases of spinal tuberculosis with neurological deficit patient is advised rest for 12-16 weeks. The patient needs to stay in bed throughout that time. No sitting or standing is allowed. The patient is allowed and encouraged in bed turning. This needs to be monitored and his response to therapy needs to be monitored failing which he might undergo surgery. This would definitely require hospitalization.
Thus an initial period of hospitalization enables supervised treatment. Continuation treatment can be on a domiciliary basis. There had been various regimes of antitubercular drugs in vogue. But with introduction of DOTS by WHO, most of physicians follow it. We would discuss DOTS shortly in another article.
Surgery
Operative intervention is required when the patient is not responding to an adequate trial of chemotherapy. Surgery aims at removing the diseased tissue and decreasing the bacterial load so as the response to drug increases.
Surgery may also be done if the therapeutic outcome is not satisfactory or an unacceptable deformity is left after the treatment. A loss of motion so severe that it hampers the activity of daily living is also an indication for surgery, if feasible.
It is also required for an unstable spine.
Most of the patients can be cured with first line drugs of tuberculosis but few might develop multidrug resistance and require second line drugs. Drugs are discussed separately.
Adequate nutritional support is also essential, as in all forms of tuberculosis.
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