Tuberculosis Arthritis and Tenosynovitis

Abstract

The incidence of extrapulmonary tuberculosis (TB) has been rising due to the increasing number of immunosuppressed patients. Musculoskeletal system accounts for 25% of extrapulmonary TB. Most of the musculoskeletal TB involves the spine. TB of peripheral joints and tendons occur infrequently, but if untreated, it can cause serious joint and tendon destruction as well as spread of the infection to the surrounding bursa, muscle, and other soft tissues. The diagnosis of TB of joints and tendons is difficult due to the nonspecific clinical manifestations and imaging features. Concurrent active pulmonary TB is present in <50% of the patients. A positive chest radiographic finding or a positive tuberculin test supports the diagnosis, but negative results do not exclude diagnosis. Although imaging features of TB of joints and tendons are nonspecific, certain findings such as relatively preserved joint space, juxta-articular osteoporosis, cold abscesses, para-articular soft tissue calcification, and rice bodies are suggestive of TB infection. Familiarity with these imaging features can help in making an early diagnosis and facilitating proper management.

Comparison of the clinical characteristics of Mycobacterium tuberculosis and nontuberculous mycobacteria patients with joint involvement

“…Chronic granulomatous inflammation with caseous necrosis is a main pathologic finding in MTB [9]. We only observed caseous necrosis in MTB.…”

“…MTB joint involvement was found to be frequent in proximal joints in our current patients. The major mechanism of MTB joint involvement is hematogenous spread [9]. Because proximal joints receive a greater blood supply than distal joints, the risk of MTB infection can be higher in proximal joints.…”

Giant Bursitis of Wrist and Multiple Tenosynovitis of Hand with Rice Body Formation: Unusual Case of an Atypical Mycobacteria Infection

“…The clinical picture of the patient is in agreement with the few cases elucidated in the literature [10]- [12]: nonspecific signs; a slow and chronic evolution; inflammatory signs discrete or absent. This insidious evolution becomes corollary of a chronicity which can be responsible for advanced lesions [13]. Osteitis [9], or bone erosion [12] is brought back in literature, in our case it was a spontaneous rupture of the flexor tendon of the 5th ray.…”

Association of Respiratory Tuberculosis with Incident Bone Fracture: Bridging the Tuberculosis Airway Infection and the Osteoporotic Bone

“…Infections such as hepatitis C virus (HCV) infection are also risk factors of osteoporosis [11]. Osteoporotic changes [12] in tuberculosis arthritis were observed in previous report [13]. However, the respiratory tuberculosis (RT) intervention associated with bone fracture among patients with or without comorbidities is not found in literature.…”