Tuberculous arthritis

Definition:

Tuberculous arthritis is an infection of the joints caused by tuberculosis. (See also spondylitis.)

Alternative Names:

Granulomatous arthritis

Causes, incidence, and risk factors:

Approximately 1% of people affected with tuberculosis will develop associated arthritis. The joints most frequently involved are the spine, hips, knees, wrists, and ankles. Most cases involve just one joint.

Tuberculosis involving the spine is often referred to as Pott's disease. The hunchback of Notre Dame had a gibbous deformity (humpback) which is thought to have been caused by tuberculosis.

Tuberculous arthritis can be very destructive. In particular, if the spine is involved, a patient may have numbness, tingling or weakness below the level of the infection. Muscle atrophy and muscle spasms can occur.

Symptoms:

Low-grade fever
Excessive sweating, especially at night
Weight loss or loss of appetite
Joint swelling with warm, tender joint(s)
Decreased joint mobility
Spinal mass, sometimes associated with numbness, tingling, or weakness of the legs

Note: Onset is usually slow and may involve only one joint.

Signs and tests:

A physical examination indicates joint inflammation.

Tests:

Joint X-rays consistent with destructive arthritis
Positive tuberculin skin test (also called PPD)
Aspiration of fluid in the joint (shows tuberculosis bacteria on a culture or stain and many white blood cells on cell count)
Biopsy of the joint (may show numerous tuberculosis bacteria)

Treatment:

Treatment is aimed at eradicating the infection with anti-tubercular medications. Analgesics and application of heat or cold to the joints may provide symptomatic relief of pain. Surgery may be necessary, especially to drain spinal abscesses or to stabilize the spine. Surgery is rarely needed for infections of other sites.

Expectations (prognosis):

This form of arthritis can be very destructive to the tissues. Control of the infection should prevent further joint involvement. However, joint destruction may take place before the infection is controlled.

Complications:

Vertebral collapse resulting in kyphosis
Spinal cord compression
Joint destruction

Calling your health care provider:

Call your health care provider if you have symptoms suggestive of this disorder, or if other possible tuberculosis symptoms are present.

Prevention:

Controlling the spread of tuberculosis infection can prevent tuberculous arthritis. Also, properly taking medicines to prevent tuberculosis by patients who have a positive PPD test (but not active tuberculosis) can decrease the risk of tuberculous arthritis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.

Review Date: 7/22/2002
Reviewed By: Sonya Shin, M.D., Infectious Diseases Division, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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