Bone & Joint Tuberculosis

Question 1

What are the different classifications of a bone/joint tuberculosis lesion?

Answer 1

Extra-articular (epiphyseal/bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body

Question 2

What are the clinical features of a bone/joint tuberculosis?

Answer 2

Insidious onset & general ill health
Contact with TB
Pain (especially at night), swelling, loss of weight
Low grade pyrexia
Joint swelling 
Decrease ROM
Ankylosis
Deformity

Question 3

What investigations should be performed if you suspect a bone/joint tuberculosis?

Answer 3

FBC, ESR
Mantoux test
Sputum/urine culture
X-ray
- soft tissue swelling
- periarticular osteopaenia
- articular space narrowing
Joint aspiration and biopsy
- AAFB identified in 10-20%
- culture +ve in 50% of cases

Question 4

What are the differential diagnoses for a bone/joint tuberculosis?

Answer 4

Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis
Tumour

Question 5

What does osteopaenia mean?

Answer 5

Weakened bones that haven’t reached the stage of osteoporosis yet - like a halfway point between osteoporosis and normal bones

Question 6

What is the treatment for bone/joint tuberculosis?

Answer 6

Chemotherapy
- initially rifampicin, isoniazid and ethambutol for 8 weeks
- then rifampicin and isoniazid for 6-12 months
Rest and splintage
Operative drainage rarely necessary