Tuberculous arthritis accounts for about 1 percent of all cases of tuberculosis and for 10 percent of extrapulmonary cases. The most common presentation is chronic granulomatous monarthritis. An unusual syndrome, Poncet’s disease, is a reactive symmetric form of polyarthritis that affects persons with visceral or disseminated tuberculosis.
No mycobacteria are found in the joints, and symptoms resolve with antituberculous therapy.
Unlike tuberculous osteomyelitis, which typically involved the thoracic and lumbar spine (50 percent of cases), tuberculous arthritis primarily involves the large weight-bearing joints, in particular the hips, knees, and ankles, and only occasionally involves smaller non weight bearing joints.
Progressive monarticular swelling and pain and develop over months to years, and systemic symptoms are seen in only half of all cases. Coexistent active pulmonary tuberculosis is unusual.
Aspiration of involved joint yields fluid with an average cell count of 20,000/µL, with approximately 50 percent neutrophils. Acid fast staining of the fluid yields positive results in fewer than one-third of cases, and cultures are positive in 80 percent.
Culture of synovial tissue taken at biopsy is positive in about 90 percent of cases and shows granulomatous inflammation inn most.
Radiographs reveal peripheral erosions at the points of synovial attachment, periarticular osteopenia, and eventually joint-space narrowing. Therapy for tuberculous arthritis is the same as that for tuberculous pulmonary disease, requiring the administration of multiple agents for 6 to 9 months.
Therapy is more prolonged in immunosuppressed individuals, such as those infected with human immunodeficiency virus .
Various atypical mycobacteria found in water and soil may cause chronic indolent arthritis. Such disease results from trauma and direct inoculation associated with farming, gardening, or aquatic activities. Smaller joints, such as the digits, wrists, and knees, are usually involved. Involvement of tendon sheaths and bursae is typical.
The mycobacterial species involved include
- M. marinum
- M. avium-intra-cellulare
- M. terrae
- M. kansassi
- M. fortuitum
- M. chelonae.
In persons who have HIV infection or are receiving immunosuppressive therapy, hematogenous spread to the joints has been reported for M. kansassi, M. avium-intracellulare, and M. haemophilum.
Diagnosis usually requires biopsy and culture, and therapy is based on antimicrobial susceptibility patterns.
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About Dr Arun Pal Singh
hii,
my brother is suffering form tubercular arithritis.
wat is the treatment..
Mohammad,
As you are mentioning the diagnosis, I presume that you have consulted a physician. Your brother must have been put on treatment.
Is there something specific that you would like to ask.
Just to mention the treatment is antitubercular drugs, rest of the affected joint followed by physiotherapy.
But the treatment needs to be individualized.
i have pain in the knee joint since yesterday. it is very severe. it statred suddenly. no h/o injury, no h/o fever. i consulted orthopedician today. he said he needed an x-ray. as im 3 months pregnant i said no. what im worried is he wanted to r/o GCT. im scared. for that he advised me ultrasound after using analgesics. can u think about alternative diagnoses. another thing is there is no swelling or local rise of temp. but i have tenderness. pls reply me. give me other probable diagnoses as i cannot wait 2 days for it to be diagnosed
Rama,
There is an endless list of things that could lead to knee pain. At this moment only this could be said about your diagnosis.
As one needs to examine the area for narrowing down on the diagnoses, your orthopedican is the best person to ask.
An xray is the basic investigation which would guide further. There are shields available which protect fetus from exposure. It is possible to get an xray with that help.
I am not sure if i would jump to a conclusion of GCT when there is just pain and no swelling but there must be reasons for your doctor to say so. Tenderness means there is a pathology. You need to be investigated further.
You can discuss the matter with your doctor.
An early diagnosis