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Tuberculous arthritis


Definition:

Tuberculous arthritis is an infection of the joints due to tuberculosis (TB).

See also: Spondylitis

Alternative Names:

Granulomatous arthritis

Causes, incidence, and risk factors:

Tuberculous arthritis is caused by the bacteria, Mycobacterium tuberculosis.

A very small number of people who have TB will develop this form of arthritis. The joints most often involved are the:

  • Ankles
  • Hips
  • Knees
  • Spine
  • Wrists

Most cases involve just one joint.

TB involving the spine is often referred to as Pott's disease. It makes up about half of all TB-related bone infections.

Symptoms:

Note: The condition usually starts slowly and usually involves only one joint.

Signs and tests:

A physical examination shows swelling and irritation (inflammation) of the joint.

Tests:

Treatment:

The goal of treatment is to cure the infection with drugs that fight the TB bacteria. Treatment of active TB will always involve a combination of many drugs (usually four drugs). All of the drugs are continued until lab tests show which medicines work best.

The most commonly used drugs include:

  • Isoniazid
  • Rifampin
  • Pyrazinamide
  • Ethambutol

Other drugs that may be used to treat TB include:

  • Amikacin
  • Ethionamide
  • Moxifloxacin
  • Para-aminosalicylic acid
  • Streptomycin

You may need to take many different pills at different times of the day for 6 months or longer. It is very important that you take the pills the way your health care provider instructed.

Your doctor or nurse is required by law to report your TB illness to the local health department. Your health care team will be sure that you receive the best care for your TB.

Taking painkillers and applying heat or cold to the joints may relieve pain. Surgery may be needed, especially to drain spinal abscesses or to stabilize the spine. Surgery is rarely needed for infections at other sites.

Expectations (prognosis):

This form of arthritis can be very destructive to the tissues. Controlling the infection should prevent more joints from becoming involved. However, joint destruction may take place before the infection is controlled.

Complications:
Calling your health care provider:

Call your health care provider if you have symptoms of this disorder, or of tuberculosis.

Prevention:

TB is a preventable disease, even in those who have been exposed to an infected person. Skin testing (PPD) for TB is used in high-risk populations or in people who may have been exposed to TB, such as health care workers.

A positive skin test indicates TB exposure and an inactive infection. Discuss preventive therapy with your doctor. People who have been exposed to TB should be skin tested immediately and have a follow-up test at a later date, if the first test is negative.

Prompt treatment is extremely important in controlling the spread of TB from those who have active TB disease to those who have never been infected with TB.

Some countries with a high incidence of TB give people a vaccination (called BCG) to prevent TB. However, the effectiveness of this vaccine is controversial, and it is not routinely used in the United States.

People who have had BCG may still be skin tested for TB. Discuss the test results (if positive) with your doctor.

References:

Barr WG, Harrington JT, Flaherty JP. Mycobacterial infections of bones and joints. In: Firestein GS, Budd RC, Harris ED, McInnes IB, Ruddy S, Sargent JS, eds. Kelley's Textbook of Rheumatology. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 101.

Fitzgerald DW, Sterling TR, Haas DW. Mycobacterium tuberculosis. In: Mandell GL, Bennett JE, Dolan R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. 7th ed. Orlando, FL: Saunders Elsevier; 2009:chap 250.


Review Date: 12/7/2010
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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