9. Tuberculous arthritis

Definition
Tuberculous arthritis is an infection of the joints caused by tuberculosis. (See also spondylitis.)

Alternative Names
Granulomatous arthritis

Causes, incidence, and risk factors
Approximately 1% of people affected with tuberculosis will develop associated arthritis. The joints most frequently involved are the spine, hips, knees, wrists, and ankles. Most cases involve just one joint.
Tuberculosis involving the spine is often referred to as Pott's disease. The fictional Hunchback of Notre Dame had a gibbous deformity (humpback) that is thought to have been caused by tuberculosis.
Tuberculous arthritis can be very destructive. In particular, if the spine is involved, a patient may have numbness, tingling or weakness below the level of the infection. Muscle atrophy and muscle spasms can occur.

Symptoms
• Low-grade fever
• Excessive sweating, especially at night
• Weight loss or loss of appetite
• Joint swelling with warm, tender joints
• Decreased joint mobility
• Spinal mass, sometimes associated with numbness, tingling, or weakness of the legs

Note: Onset is usually slow and may involve only one joint.

Signs and tests
A physical examination indicates joint inflammation.
Tests:
• Joint x-rays consistent with destructive arthritis
• Positive tuberculin skin test (also called PPD)
• Aspiration of fluid in the joint (shows tuberculosis bacteria on a culture or stain and many white blood cells on cell count)
• Biopsy of the joint (may show numerous tuberculosis bacteria)

Treatment
Treatment is aimed at eradicating the infection with anti-tubercular medications. Analgesics and application of heat or cold to the joints may provide relief of pain. Surgery may be necessary, especially to drain spinal abscesses or to stabilize the spine. Surgery is rarely needed for infections of other sites.

Expectations (prognosis)
This form of arthritis can be very destructive to the tissues. Control of the infection should prevent further joint involvement. However, joint destruction may take place before the infection is controlled.

Complications
• Vertebral collapse resulting in kyphosis
• Spinal cord compression
• Joint destruction

Calling your health care provider
Call your health care provider if you have symptoms suggestive of this disorder, or if other possible tuberculosis symptoms are present.

Prevention
Controlling the spread of tuberculosis infection can prevent tuberculous arthritis. Patients who have a positive PPD test (but not active tuberculosis) may decrease their risk of tuberculous arthritis by properly taking medicines to prevent tuberculosis. To effectively treat tuberculosis, it is crucial that patients take their medications exactly as prescribed.

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