Tuberculous arthritis

Definition

Tuberculous arthritis is an infection of the joints due to tuberculosis (TB).

See also: Spondylitis

Alternative Names

Granulomatous arthritis

Causes, incidence, and risk factors

Approximately small number of people who have TB will develop this form of arthritis. The joints most often involved are the:

• Ankles
• Hips
• Knees
• Spine
• Wrists

Most cases involve just one joint.

TB involving the spine is often referred to as Pott's disease. The fictional Hunchback of Notre Dame had a humpback that is thought to have been caused by tuberculosis.

Symptoms

• Decreased movement in the joints
• Excessive sweating, especially at night
• Joint swelling with warm, tender joints
• Low-grade fever
• Muscle atrophy
• Muscle spasms
• Numbness, tingling, or weakness below the infection (if the spine is involved)
• Weight loss or loss of appetite

Note: The condition usually starts slowly and may involve only one joint.

Signs and tests

A physical examination shows swelling and irritation (inflammation) of the joint.

Tests:

• Aspiration of fluid in the joint
• Biopsy of the joint to detect the bacteria that causes TB
• Chest x-ray
• CT scan of the spine
• Joint x-rays
• Tuberculin skin test (also called PPD)

Treatment

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active pulmonary TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best.

The most commonly used drugs include:

• Isonizid
• Rifampin
• Pyrazinamide
• Ethambutol

Other drugs that may be used to treat TB include:

• Amikacin
• Ethionamide
• Moxifloxacin
• Para-aminosalicylic acid
• Streptomycin

You may need to take many different pills at different times of the day for 1 year or longer. It is very important that you take the pills the way your health care provider instructed.

Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care for your TB.

Taking painkillers and applying heat or cold to the joints may relieve pain. Surgery may be needed, especially to drain spinal abscesses or to stabilize the spine. Surgery is rarely needed for infections at other sites.

Expectations (prognosis)

This form of arthritis can be very destructive to the tissues. Controlling the infection should prevent more joints from becoming involved. However, joint destruction may take place before the infection is controlled.

Complications

• Collapse of the vertebrae, resulting in kyphosis
• Joint destruction
• Spinal cord compression

Calling your health care provider

Call your health care provider if you have symptoms of this disorder, or of tuberculosis.

Prevention

TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing (PPD) for TB is used in high risk populations or in people who may have been exposed to TB, such as health care workers.

A positive skin test indicates TB exposure and an inactive infection. Discuss preventive therapy with your doctor. People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the first test is negative.

Prompt treatment is extremely important in controlling the spread of TB from those who have active TB disease to those who have never been infected with TB.

Some countries with a high incidence of TB give people a vaccination (called BCG) to prevent TB. However, the effectiveness of this vaccine is controversial and it is not routinely used in the United States.

People who have had BCG may still be skin tested for TB. Discuss the test results (if positive) with your doctor.

References

Alparsian L, Yu JS, Weissman BN. Imaging. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 51.

McCune WJ, Golbus J. Monarticular arthritis. In: Harris ED, Budd RC, Genovese MC, Firestein GS, Sargent JS, Sledge CB, eds. Kelley's Textbook of Rheumatology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2005: chap 34.