General principles of osteoarticular tuberculosis

Area of Science:

• Infectious Diseases
• Orthopedic Surgery
• Public Health

Background:

• The human immunodeficiency virus (HIV) pandemic and increased immunocompromised populations since 1985 have led to a global resurgence of tuberculosis.
• Osteoarticular tuberculosis diagnosis typically relies on clinical and radiological findings in endemic areas, but tissue diagnosis is crucial for atypical presentations.

Purpose of the Study:

• To review the diagnosis, treatment, and management of osteoarticular tuberculosis, particularly in the context of increased global incidence.
• To highlight the importance of early intervention and the challenges posed by multidrug-resistant tuberculosis.

Main Methods:

• Review of diagnostic approaches including clinical, radiological, and tissue-based methods.
• Discussion of treatment strategies, encompassing multidrug antituberculous chemotherapy, physical therapy, and surgical interventions.
• Exploration of management for multidrug-resistant cases.

Main Results:

• Early diagnosis and treatment of osteoarticular tuberculosis result in healing with near-normal function in 90-95% of patients.
• Multidrug antituberculous chemotherapy for 12-18 months combined with physical therapy is the primary treatment.
• Surgical intervention is reserved for non-responsive cases, unsatisfactory outcomes, or painful ankylosis.

Conclusions:

• Prompt diagnosis and a comprehensive treatment plan involving chemotherapy and physical therapy are vital for successful osteoarticular tuberculosis management.
• Multidrug resistance presents a significant therapeutic challenge, requiring second-line drugs and potential immunomodulation.
• Long-term follow-up and consideration for joint replacement in inactive cases are important aspects of patient care.