Skeletal Tuberculosis
Aka: Skeletal Tuberculosis, Tuberculous Arthritis, Pott’s Disease, Poncet’s Disease, Spinal Tuberculosis, Articular Tuberculosis, Tuberculous Osteomyelitis, Gibbus
II. Definition
- Arthritis secondary to Mycobacterium tuberculosis
III. Epidemiology
- Represents 35% of Extrapulmonary Tuberculosis
IV. Distribution
- Spinal Tuberculosis (Pott’s Disease)
- Thoracic Spine most commonly involved
- Associated with paraspinous abscess
- Destroys anterior Vertebral body and adjacent disc
- Results in anterior wedging
- Forms prominence of spine known as Gibbus
- May compress central cord
- Articular Tuberculosis (most common involvement)
- Monoarticular Arthritis of weight bearing joints
- Presents with insidious monoarticular pain, swelling
- May form superficial abscesses and drain to skin
- Poncet’s Disease (rare)
- Acute sterile Polyarthritis
- Associated with visceral involvement
- Tuberculous Osteomyelitis
- May involve any bone
V. Signs
- Doughy synovitis on joint palpation
VI. Labs
- Tuberculin Skin Test (Purified Protein Derivative)
- Positive in most cases
- Synovial Fluid Exam
- See Septic Arthritis
VII. Radiology: Chest XRay
- Pulmonary involvement in only 50% of Tb Arthritis
VIII. Diagnosis
- Arthrocentesis with Mycobacterium tuberculosis culture
- Test Sensitivity: 80%
- Synovial biopsy
IX. Management
- See Extrapulmonary Tuberculosis
- See Tuberculosis Management
- Four drug regimen
- Isoniazid for 10 to 24 months
- Rifampin for 10 to 24 months
- Pyrazinamide for 2 months
- Ethambutol until Tuberculosis sensitivity established
- Atypical Mycobacteria require fifth drug added