TB in da Bone

Question 1

How do we classify TB bone infections?

Answer 1

Geographically:

• Extra-articular (epiphyseal plate)
• Intra-articular (large joints)
• Vertebral body

1/3rd of patients have it in multiple sites

Question 2

How does TB bone infection present?

Answer 2

Pain, swelling and weight loss
Low grade fever
Decreased ROM
~Ankylosis and deformity

Look for a TB history and an Insidious onset

Question 3

Whats the most common form of TB bone infection and how does it present?

Answer 3

Spinal TB (aka pott's disease)
Little pain or illness but an abscess and kyphosis of the spine.
Generally don't present until they reach the point of vertebral body collapse, which can be seen on X-ray and is normally either TB or cancer

Question 4

What tests would we use for Diagnosing TB?

Answer 4

X-ray
Sputum/urine cultures
Mantoux Test
FBC
ESR
Joint aspiration & biopsy

ALso looked for marked muscle wasting

Question 5

How would bony TB show up on X-ray?

Answer 5

• Periarticular Osteoporosis
• Synovium thickening –> narrowed articular space
• Soft tissue swelling

Question 6

DDX for TB?

Answer 6

TRansient synovitis
Monoarticular RA
Haemorrhagic Arthritis
Pyogenic Arthritis
Tumour

Question 7

How do we treat TB in the bone?

Answer 7

Rest and splintage
Rarely operative drainage
Meds

Question 8

Describe the drug regimen to clear TB from the bone?

Answer 8

8 wks of Rifampicin + Isoniazid + Ethambutol

then 6-12 months of Rifampicin + Isoniazid