Tuberculosis

Question 1

What is tuberculosis of bone and joints?

Answer 1

Bone TB is one of the extrapulmonary TBs that primarily affects the spine. It is an infective disease

Question 2

What are the classifications of bone Tuberculosis?

Answer 2

• Extra-articular (epiphyseal/bones with haemodynamic marrow)
• Intra-articular (large joints)
• Vertebral body

Question 3

Clinical features of tuberculosis?

Answer 3

• Insidious onset and general ill health
• Contact with TB
• Pain, swelling, loss of weight
• Low grade pyrexia
• Ankylosis
• Deformity

Question 4

What are the 3 steps of pathogenesis of Tuberculosis?

Answer 4

• Primary complex (in lung or gut)
• Secondary spread
• TB granuloma

Question 5

How does spinal tuberculosis present?

Answer 5

• Little pain
• Present with abscess or kyphosis

Question 6

On history/examination what would make you suspect TB as diagnosis?

Answer 6

• Long history
• Involvement of single joint
• Marked thickening of synovium
• Marked muscle wasting
• Periarticular osteoperosis

Question 7

What investigations would you carry out for TB?

Answer 7

• FBC, ESR
• Mantoux test
• Sputum, urine culture
• Xray: soft tissue swelling, periarticular osteopenia, articular space narrowing
• Joint aspiration and biopsy

Question 8

DDx for tuberculosis?

Answer 8

• Transient synovitis
• Monoarticular RA
• Haemorrhagic arthritis
• Pyogenic arthritis
• Tumour

Question 9

Tx for Tuberculosis?

Answer 9

Intitial: Rifampicin, Isoniazid, Ethambutol - 8 wks

Then: rifampicin and isoniazid for 6-12 months

Rest and splintage

Operative drainage if necessary