Skeletal tuberculosis. A review with patient presentations and discussion

Abstract

Skeletal tuberculosis occurs in approximately 1 per cent of patients with tuberculosis. The pathogenesis, pathology, clinical aspects, diagnosis and treatment are discussed. Four patients are presented to illustrate the following important clinical problems concerning this disease: (1) Clinical evidence of tuberculosis may be present many years before diagnosis. One must think of it to diagnose it. (2) A previous history of tuberculosis or exposure, no matter how remote, is important and should always be sought when destructive bone and joint lesions are present. (3) Any monoarticular arthritis, particularly with a destructive lesion, is suspect, and purified protein derivative skin test should be performed as a minimum. (4) Multiple sites of bone and joint involvement commonly occur and must always be considered. (5) Approximately 50 per cent of the patients with bone tuberculosis do not have concomitant tuberculosis in the lung. (6) Pathologic specimens which are compatible with tuberculosis or granuloma should be suspect, even if the organism is not demonstrated. (7) When tuberculosis is present, adequate chemotherapy should be instituted prior to surgical procedures if possible. (8) Good treatment results from chemotherapy alone are possible, even in far advanced joint disease. In unusual instances surgical intervention may be necessary to improve joint function. (9) Persistent bone pain particularly in the spine should suggest evaluation for tuberculosis. (10) Early diagnosis is essential since excellent therapy is available and far advanced destruction and long suffering and disability can be avoided. © 1970.