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Tuberculosis of bones and joints is a disease whose essence is infection with mycobacteria tuberculosis and inflammatory-necrotic-cheese changes in the skeleton. Mycobacteria of tuberculosis can settle in any part of the osteoarticular system, but most often they are located in the vertebrae of the spine and the articular parts of long bones.
Tuberculosis of bones and joints – definition
Tuberculosis of bones and joints 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.
The causes of tuberculosis of bones and joints
It causes tuberculosis of bones and joints Mycobacterium tuberculosis, rarely 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, tuberculosis of the bones and joints 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.
Tuberculosis of bones and joints – symptoms
The disease process is uncharacteristic in the initial stage of bone and joint tuberculosis. 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). As a result of a wedge-shaped fracture of the vertebral bodies, the so-called tuberculosis hump.
General symptoms in the form of high temperature, night sweating or general weakness and weight loss – may or may not occur in the active phase of the disease. Active pulmonary tuberculosis is found in half of the patients, while in 20-45% the involvement of the genitourinary system
Radiological examination of a given area reveals a more or less extensive infiltration, destruction of bone tissue, defects of its structure in some places, and more intense calcifications in others, fractures, etc. Tuberculous arthritis is usually confined to a single joint, such as the knee joint. It is very often a consequence of the penetration of a specific inflammatory process into the soft tissues of the joint. It is usually accompanied by: exudation into the joint cavity, changes in the contours of the joint (edema) and sometimes skin reddening. Sometimes a previously inflicted injury to a given joint may be a predisposing factor to the development of tuberculous arthritis.
Diagnosis of tuberculosis of bones and joints
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 tuberculosis of bones and joints 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 bone and joint tuberculosis from other conditions. Consider, for example, chronic osteoarthritis, also 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.
How to treat tuberculosis of bones and joints?
In the treatment of tuberculosis of the bones and joints, drugs similar to those used in pulmonary tuberculosis, i.e. anti-tuberculosis 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.
What’s the prognosis?
In early cases, the prognosis is rather favorable.