Pitfalls in the diagnosis of tuberculous arthritis
Finsterbush, A.; Husseini, N.; Mann, G.; Shaul, J.
Harefuah 120(2): 62-66
1991
ISSN/ISBN: 0017-7768 PMID: 2007489 Document Number: 371768
Jewish immigrants from Russia, and Arabs added to the population register since 1967, have a relatively high incidence of bone and joint tuberculosis. These patients now account for most of this disease in Israel. Skeletal tuberculosis imitates various joint conditions, most commonly, rheumatoid arthritis, and therefore presents a diagnostic problem. Injections of corticosteroids and/or immunosuppressive therapy can reactivate quiescent tuberculous lesions. During a 12-year period 14 patients with tuberculous arthritis involving 16 joints were seen in this hospital. They included 9 males and 5 females, 14-70 years old, 4 of whom were known to have had previous skeletal tuberculosis: 3 had spinal and 1 had hip involvement. None of the other 10 had a clinical history of tuberculosis, nor x-ray evidence of active pulmonary disease. 7 patients were diagnosed postoperatively as having joint tuberculosis on histopathological and bacteriological examination; 3 had positive cultures from joint aspirations. Most commonly involved were the spine and knee - 4 cases of each. The wrist and acromioclavicular joint were affected in 2 cases each, and the hip, sacroiliac joint, ankle and elbow joints in 1 case each. The youngest patient, 14 years old, had triple-joint involvement of the wrist and the acromioclavicular and sacroiliac joints; the others had single-joint disease. In 1 patient the disease was reactivated after 36 years by surgical conversion of a fused hip to a mobile artificial joint. 3, whose joints were injected with corticosteroids, developed active, destructive tuberculous arthritis. A patient with rheumatoid arthritis who underwent total knee replacement was found to have active tuberculous arthritis. Drug treatment was with daily doses of isoniazid (300 mg), rifampin (600 mg) and ethambutol (800 mg) for at least 6 months. In cases of artificial joint replacement treatment was prolonged for an additional 6 months. This drug regime gave satisfactory results. In the case of weight-bearing joints of the lower limbs in which joint destruction was extreme, complementary surgery, including synovectomy debridement, or fusion, was needed.