ARTHRITIS-TUBERCULOUS

SUMMARY

1. Tuberculous arthritis typically presents as an indolent chronic monoarthritis (months to years) of the hip and knees.

2. Most patients do not have associated active pulmonary TB.

3. Biopsy of the synovium for pathology and culture is most helpful (shows graulomas), send fluid for PCR.

4. Treatment is the same as for active pulmonary TB: isoniazid, rifampin, pyrazinamide, and ethambutol x 2 months-until you get the organism and its sensitivities.

5. Then, narrow therapy to 2 drugs x 4-7 more months (6-9 months total). Treat longer if the patient is HIV⁺.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].