Overview of Tuberculous Arthritis

Tuberculous arthritis symptoms

TB arthritis most commonly develops in the:

• spine (40%)
• hip (25%)
• knee (8%)

More rarely, it can develop in joints such as your ankle or wrist. When it occurs in your spine, it most often affects the thoracic spine, which is your mid-back.

TB arthritis usually causes slow-progressing symptoms that affect one joint. It may be mistaken for other forms of arthritis such as rheumatoid arthritis.

Symptoms include:

• pain
• swelling
• reduced range of motion

TB arthritis often doesn’t cause redness or warmth around the joint. Blood tests often show elevated inflammatory markers.

About half of people have respiratory symptoms and up to a third of people report fever and weight loss. If you also have pulmonary tuberculosis, you may have respiratory symptoms such as:

• coughing
• chest pain
• pain when breathing
• coughing up blood

Tuberculosis with arthritis causes

Mycobacterium tuberculosisis spread almost exclusively by breathing in respiratory fluids through the air passed from one person to another. These fluids can be spread by:

• talking
• singing
• coughing

Bacteria in these fluids can enter your lungs and multiply. From your lungs, the bacteria can travel through your bloodstream to other parts of your body such as your joints.

Who gets tuberculous arthritis?

Tuberculosis affects about a third of the world’s population, and it’s most common in developing countries. It’s one of the top 10 causes of death worldwide. You’re most likely to develop TB arthritis if you visit a country where tuberculosis is common.

About 10–35% of people with tuberculosisoutside their lungs develop musculoskeletal symptoms, meaning symptoms that affect their:

• muscles
• bones
• joints

People with HIV who develop tuberculosis have a higher chance of developing symptoms outside their lungs.

Potential complications of tuberculous arthritis?

TB arthritis can lead to the destruction of the bones around your joints. The destruction of cartilage usually doesn’t occur until the disease has progressed to an advanced stage since the bacterium doesn’t have enzymes to break it down.

Severe arthritis can cause permanent complications, such as:

• disability
• joint structural changes
• chronic pain

Some people with active tuberculosis develop Poncet disease. Poncet disease is a form of multi-joint arthritis triggered by tuberculosis without any sign of bacteria in your joints. It’s classified as a type of reactive arthritis.

TB arthritis generally isn’t infectious when it occurs in body parts outside of your lungs.

When to contact a doctor

According to the Arthritis Foundation, it’s important to see a doctor if you have joint symptoms that last 3 days or more or have several episodes of joint symptoms within 1 month.

It’s also important to contact a doctor if you develop pulmonary tuberculosis symptoms, especially if you traveled to an area where tuberculosis is common or had a known exposure.

Tuberculous arthritis diagnosis

Doctors make a diagnosis of TB arthritis with tests such as:

• an examination of your medical history
• reviewing your symptoms
• performing a physical exam
• ordering X-rays and MRI scans
• blood tests to look for inflammatory markers
• a small tissue sample from your joint called a biopsy

TB arthritis can be difficult to diagnose because signs of the disease seen with imaging can be similar to other forms of arthritis. It’s often misdiagnosed as rheumatoid arthritis.

A biopsy is often needed to confirm a TB arthritis diagnosis. Doctors can use this tissue sample to look for signs of bacterial infection in a laboratory. A bacterial culture is the gold standard test.

Tuberculous arthritis treatment

Antituberculosis drug therapy is the main treatment for the infection. A doctor may give you a 6-month course of:

• isoniazid (Hydra, Hyzyd, Isovit)
• rifampicin (Rifadin)
• pyrazinamide (Rifater, Rimstar, Voractiv)
• ethambutol (Myambutol)

Although uncommon, tuberculosis can trigger rheumatoid arthritis, which is when your immune system attacks healthy cells in your joints. Treatments for rheumatoid arthritis include:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids
• disease-modifying antirheumatic drugs
• biologics

Can you prevent tuberculous arthritis?

You can prevent TB arthritis by:

• avoiding close contact with people with pulmonary tuberculosis
• getting a tuberculosis blood test before leaving the United States and 8–10 weeks after returning if you’re going to be in contact with people at high risk of having tuberculosis during your travels
• taking steps to avoid HIV, which may increase your risk of developing tuberculosis outside your lungs, such as:
  • avoiding sharing injection equipment
  • using a condom or other barrier method when having sex
  • taking postexposure prophylaxis (PEP) if you think you’ve been exposed

The tuberculosis vaccine isn’t commonly used in the United States, but it’s given to infants and children in countries where it’s common. It may be considered for people at a high risk of exposure.

Frequently asked questions about tuberculous arthritis

Here are some frequently asked questions people have about TB arthritis.

What is the difference between TB arthritis and rheumatoid arthritis?

TB arthritis is caused by an infection of the bacteria Mycobacterium tuberculosis. Rheumatoid arthritis is an autoimmune condition that develops when your immune system attacks healthy cells in your joints. TB arthritis can trigger rheumatoid arthritis.

Is TB arthritis curable?

TB arthritis can be potentially cured with antituberculosis drugs. But if diagnosis is delayed, the disease can cause severe joint destruction that causes lifelong symptoms.

Takeaway

TB arthritis can be mistaken for other forms of arthritis, such as rheumatoid arthritis. Prompt treatment with antituberculosis medication is needed to prevent long-term joint damage.