Tuberculous Arthritis: A Forgotten Diagnosis During Pandemic Covid-19 (original) (raw)

Tuberculosis Arthritis: Epidemiology, Diagnosis, Treatment

Clinical Research on Foot & Ankle, 2014

Tuberculosis (TB) arthritis accounts for approximately 1-3% of all cases of tuberculosis and for approximately 10-11% of extrapulmonary cases. TB arthritis primarily involves the large weight-bearing joints, in particular the hips, knees, and ankles, and occasionally involves smaller nonweight-bearing joints. The diagnosis of TB arthritis is often delayed due to lack of awareness, insidious onset, lack of characteristic early radiographic findings and often lack of constitutional or pulmonary involvement. Intense current and previous efforts into diagnostic, therapeutic, and preventive interventions have focused on pulmonary TB in adults, but TB arthritis has been relatively neglected. Additional research, understanding, and prevention of TB arthritis are urgently needed. In this article, we review the epidemiology, diagnosis, and principles of treatment of TB arthritis.

The Challenge of Tuberculosis Arthritis Differential Diagnosis

JCR: Journal of Clinical Rheumatology, 2019

T uberculosis (Tb) is an infectious disease that still represents a serious public health problem, causing a significant burden in health care worldwide, particularly in developing countries. One-third of world population has already been in contact with Tb, and approximately 2 million people die per year due to the infection. In Brazil, the incidence of pulmonary Tb remains high (34.8 cases per 100,000 inhabitants), especially in Amazonas (72.9 cases per 100,000 inhabitants), ranking first in Brazil with high mortality rate in 2018. 1 Although the lung is the primary site involved, bones and joints are affected in 1% to 3% of patients. 2 Bone and joint infection may account for approximately 14% of extrapulmonary Tb cases. 3 The spine is the most affected site, followed by the hips, knees, and small-sized joints. Signs and symptoms are generally nonspecific, and more than 50% of patients do not have concomitant lung disease. Acute Tb septic arthritis is usually monoarticular, and the organism is capable of being isolated. Synovial biopsy is the criterion standard for diagnosis, and it results positive in 80% of the cases. 2,4 Joint and bone infections are rheumatologic emergencies given their high morbidity and mortality. 5 The authors report 4 cases of Tb septic arthritis, whose diagnoses were difficult to make, thus warning physicians on the need for suspicion and early treatment, mainly in endemic areas, in order to contribute to better prognosis.

Delayed Diagnosis of Tuberculous Arthritis

2005

Monoarticular tuberculosis (TB) affecting the knee is rare in all forms of TB (0.1 -0.3%). We present the case of a patient with tuberculous arthritis in whom the diagnosis was belated due to a lack of familiarity with the disease; here, we emphasize the difficulties associated with the diagnosing joint TB. A 20year-old man was referred to our department due to swelling of the right knee and the presence of persistent, mild pain for 4 years. The lack of systemic evidence of this disease, the indolent course of disease, and the presence of non-specific symptoms renders early recognition of this disease difficult. Furthermore, in cases in which a diagnosis cannot be reached simply by culturing the synovial fluid, synovial biopsy cultures should be considered in the diagnostic process, due to the high rate of positivity of such cultures. The diagnosis and treatment of articular TB are both urgent matters; surgical debridement and strict adherence to antituberculous chemotherapy tend to yield a satisfactory functional outcome.

Arthritis associated with tuberculosis

Best Practice & Research Clinical Rheumatology, 2003

There has been a resurgence in tuberculosis (TB) worldwide. Approximately 2 billion people have latent infection, 8 million would develop active TB annually, and 2-3 million would die due to TB. With this resurgence, cases with extrapulmonary TB have also shown an increase. Approximately 10-11% of extrapulmonary TB involves joints and bones, which is approximately 1-3% of all TB cases. The global prevalence of latent joint and bone TB is approximately 19-38 million. TB arthritis most commonly manifests as a monoarthritis of weight-bearing joints in the hip or the knee. Oligo-or polyarticular presentation is not rare and may cause diagnostic confusion with inflammatory arthritis. Owing to the low incidence in developed countries, the diagnosis of joint and bone TB is often delayed. A high degree of sensitivity to this diagnosis would prevent delays, permitting prompt institution of anti-TB therapy and preventing irreversible joint damage. Despite advances, confirmation of diagnosis still relies on lengthy microbiological techniques or invasive biopsy. Due to the frequency of isoniazid resistance, initial treatment at present typically includes a combination of four drugs: isoniazid, rifampicin, pyrazinamide and streptomycin or ethambutol. Antimicrobial therapy should be of at least 9 months duration, longer in children and immunocompromised hosts. Surgical procedures should be restricted to joints with severe cartilage destruction, large abscesses, joint deformity, multiple drug resistance or atypical mycobacteria.

TUBERCULOUS ARTHROPATHY OF THE ELBOW JOINT: A CASE REPORT

Tuberculosis arthritis is a rare form of extrapulmonary tuberculosis affecting 1-3% of the population. The diagnosis of TB arthritis is challenging since different diseases mimic its presentation. However, early detection and treatment are very crucial to have better prognosis and outcome. Musculoskeletal tuberculosis most commonly affects the spine, followed by the weight bearing joints like the hip and knee joints. The elbow joint is rarely involved in musculoskeletal tuberculosis and represents 1-5% of musculoskeletal tuberculosis cases. Here we are reporting a 75-year-old male known case of pulmonary TB presented with right elbow swelling and pain, and diagnosed with TB arthritis based on clinical history and exam, imaging, and joint fluid aspiration.

Tuberculosis of the wrist mimicking rheumatoid arthritis – A rare case

International Journal of Surgery Case Reports, 2019

INTRODUCTION: Mycobacterium tuberculosis causes infection in approximately one-third of the world's population. Arthritis due to Mycobacteriurn tuberculosis usually presents as a chronic, slowly progressive, monoarticular infection that predominantly involves the weight-bearing joints and the spine. The hand and wrist are rare sites for tuberculosis (TB) and comprises of < 1% of all skeletal TB. Even though it is rare, TB of the wrist is a cause of great morbidity. We presented a case of wrist TB treated with debridement and synovectomy. PRESENTATION OF CASE: A 35 years old woman came with the chief complaint of pain and swelling on the right wrist since 1 year ago and was diagnosed with rheumatoid arthritis of the wrist. Patient then was given methylprednisolone 4 mg twice a day and methotrexate 175 mg once a week. However, the pain and swelling of her right wrist became worse. Subsequently patient was admitted to hospital and laboratory findings suggested a tuberculous arthritis of the wrist. Debridement, synovectomy, and biopsy, in addition to antituberculosis therapy, were then performed. DISCUSSION: Tuberculous arthritis is generally a monoarticular disease that typically involves the spine or large and medium-sized joints. Rheumatoid arthritis (RA) and tuberculous arthritis may have similar clinical characteristics, which consists of a chronic course with periarticular soft-tissue swelling. CONCLUSION: Tuberculous arthritis and RA can have similar characteristic but laboratory examination can help in establishing diagnosis.

Tuberculous Arthritis of the Elbow Joint: An Uncommon Location with a Diagnostic Dilemma

Cureus, 2018

Musculoskeletal tuberculosis accounts for 1%-3% of all cases of tuberculosis (TB) worldwide with elbow involvement being even less common. The most cases of tuberculous arthritis occur in patients born in and emigrated from endemic regions, especially in patients who are co-infected with human immunodeficiency virus (HIV). We present a rare case of tuberculous septic arthritis of the elbow joint in a 78-year-old African-American female from the United States, with no history of travel abroad. Her presenting symptoms included pain, swelling, and decreased range of motion of the right elbow for six months. She underwent incision and debridement of the elbow joint and was started on empiric intravenous antibiotic therapy for suspected pyogenic septic arthritis. Several weeks later, surgical cultures demonstrated acid-fast bacilli, identified as Mycobacterium tuberculosis (M. tuberculosis) and a four-drug anti-tuberculosis regimen was initiated. Based upon culture results, additional im...

Tuberculosis presenting as arthritis of the ankle: A case report

SAGE Open Medical Case Reports, 2021

Tuberculosis presenting as monoarticular involvement in immunocompetent patients is rare. Here, we report a Sri Lankan patient presenting with ankle swelling due to tuberculosis with no other extrapulmonary or pulmonary involvement. Magnetic resonance imaging showed destruction of articular cartilage of the ankle joint with chronic inflammation of the subtalar joint. The diagnosis was confirmed by synovial tissue culture which was positive for Mycobacterium tuberculosis. The patient recovered uneventfully with anti-tuberculosis treatment. Therefore, a high degree of suspicion is necessary to diagnose extrapulmonary tuberculosis when patients are presenting with atypical monoarthritis.

Musculoskeletal Tuberculosis: A Multifaceted Foe

Annals of the National Academy of Medical Sciences (India)

Tuberculosis (TB) still remains a global epidemic, and India accounts for one-fourth of the world's TB burden. The incidence of extrapulmonary TB has relatively remained constant, but with the introduction of antitumor necrosis factor, there has been a surge in pulmonary and extrapulmonary TB cases presenting to rheumatologists. Musculoskeletal TB accounts for 10 to 30% of all cases of extrapulmonary TB, with spondylitis (Pott's spine) being the most common manifestation. Manifestations mimicking autoimmune spondylitis are seen in 10% of cases. Tubercular arthritis most commonly presents with large joint monoarthritis, but oligo- or polyarticular involvement is also seen. Poncet's disease is a form of reactive arthritis occurring in patients with pulmonary or extrapulmonary TB, which is rarely seen with good response to antitubercular treatment. Quite often, there is delay in the diagnosis of musculoskeletal TB due to absence of constitutional symptoms. Treatment of musc...