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Osteoarticular tuberculosis is a secondary focus that appears as a consequence of the spread of mycobacteria by blood from primary foci, which are most often located in the lungs, paribronchial lymph nodes, and less frequently in the gastrointestinal tract. It is a process caused by the mycobacterium tuberculosis of the human or bovine type. The most common localization of the tuberculous process is: the spine, hip joints, knee, less often the metacarpal bones, metatarsus, and phalanges.
Definition of osteoarticular tuberculosis
Osteoarticular tuberculosis is the most common form of tuberculosis (apart from pulmonary tuberculosis). It occurs as a result of infection with tuberculosis mycobacteria by blood from primary foci, e.g. lungs or lymph nodes near the bronchi. The formation of inflammatory-necrotic-cheese lesions in the skeleton is characteristic. Tuberculosis mycobacteria are most often located in the vertebrae of the spine, hip joint, knee joint or metatarsus.
In Poland, this disease is the fourth most common localization of tuberculosis in Poland. In the past, tuberculosis of bones and joints was considered a disease affecting mainly children and young people. Tuberculosis affects both men and women to the same extent.
Osteoarticular tuberculosis – causes of formation
Osteoarticular tuberculosis is caused by Mycobacterium tuberculosis, rarely by M. bovis. The most common infection of the osteoarticular system occurs through the blood or lymph from primary lesions located in the lymph nodes, the gastrointestinal tract or the lungs.
In children, osteoarticular tuberculosis usually appears as a consequence of a primary infection. Often past injuries to the locomotor system contribute to the appearance of ailments. It happens that the tuberculosis bacilli remain dormant in the body for many years before the disease becomes active. While bone and joint tuberculosis can affect all bones and joints, the spine is the most common location. In adults, lesions are usually located in the lower thoracic and lumbar sections, and in children, the upper thoracic spine and the cervical spine. As for the joints, the hip joint is the most stressed, less often the wrist, elbow or ankle joint. Although the lesions are confined to one bone or joint, it happens that in children or elderly people with low immunity – the disease is multifocal.
Symptoms of osteoarticular tuberculosis
In the initial stage of osteoarticular tuberculosis, the disease process is uncharacteristic. The ailment may develop discreetly and asymptomatically. Bone pain begins with time. As the disease progresses, the pain worsens, there is swelling in a specific part of the skeletal system, and even spontaneous (i.e. without trauma or stress) fractures. If tuberculous lesions concern the vertebral bodies of the spine, they can manifest themselves as various root syndromes (e.g. intercostal and lumbar neuralgia, i.e. lumbago and sciatica).
Other symptoms:
- low-grade fever,
- general weakness,
- excessive sweating,
- pale skin,
- anemia,
- getting tired quickly,
- rheumatic pain,
- locally soreness that intensifies with movements,
- night pain, enlarged lymph nodes,
- muscle atrophy
- joint thickening,
- contractures.
Later, the so-called tuberculosis hump due to the wedge-shaped collapse of the shafts. In articular tuberculosis, the infection may come from the synovium of the joint or from the bone focus adjacent to the joint.
How to recognize osteoarticular tuberculosis?
The diagnosis of this ailment is not easy and usually it is made too late (it can be even several years delay). Then the changes are very intense and often irreversible. In the early stages of the disease, no changes are often detected or a slight swelling of the soft tissues is revealed.
The diagnosis of osteoarticular tuberculosis is based on the detection of tuberculosis mycobacteria and the presence of tuberculous granulation tissue in the material collected from lesions. The material can be taken from synovial fluid, purulent content or a synovial biopsy. Thanks to the histopathological examination, tuberculosis can be diagnosed in almost 90% of patients. Treatment is initiated even when tuberculous granulation tissue is present, but there is no bacteriological confirmation of the disease.
Sometimes, computed tomography is also performed, thanks to which it is possible to visualize early degenerative changes that are not visible in radiological examination. The examination allows to visualize the shape of the calcifications within the abscess and to determine the place from which the material for examination can be taken. Another test is the magentic resonance, which is a sensitive imaging method. It shows changes in the area of the spine and surrounding soft tissues.
It is also important to differentiate osteoarticular tuberculosis from other ailments. Consideration should be given, for example, to chronic osteoarthritis caused by fungi or bacteria. In addition, it is necessary to exclude neoplastic disease and such ailments as:
- rheumatoid arthritis,
- sarcoidosis,
- Sudeten’s disease,
- syphilis,
- actinomycetes,
- brucellosis.
Treatment of osteoarticular tuberculosis
In the treatment of osteoarticular tuberculosis, drugs similar to those used in pulmonary tuberculosis, i.e. antituberculosis preparations, are implemented. Usually, the maintenance phase is extended to a total treatment duration of 9 months. Thanks to proper diagnostics and quick diagnosis, it is possible to prevent damage and permanent disability. Surgical procedures are usually performed for diagnostic purposes, e.g. drainage. However, there are situations in which it is necessary to have spinal tuberculosis surgery in which severe neurological disorders and deformities have occurred. The indication for the procedure may also be the destruction of the joint and the surrounding tissues, which in turn leads to its instability. In early cases, the prognosis is rather favorable.