Extraspinal tuberculous arthritis in HIV era.

Area of Science:

• Rheumatology
• Infectious Diseases
• Public Health

Background:

• A global resurgence of tuberculosis (TB) is evident, with a disproportionate increase in extrapulmonary TB cases.
• Human immunodeficiency virus (HIV) infection is a recognized factor contributing to the rise in TB incidence.

Purpose of the Study:

• To investigate the clinical features and laboratory findings of patients with peripheral tuberculous arthritis.
• To determine the association between extraspinal tuberculous arthritis and HIV infection.

Main Methods:

• Retrospective review of medical records for 27 patients diagnosed with extraspinal tuberculous arthritis between January 1994 and December 2002.
• Diagnosis confirmed by clinical presentation, Mycobacterium tuberculosis culture, or histological examination of caseating granuloma.
• Analysis included patient demographics, disease duration, affected joints, pulmonary involvement, and HIV status.

Main Results:

• The average patient age was 49.3 years, with 52% being male. Mean disease duration before treatment and diagnosis was 10.2+11 and 25 weeks, respectively.
• Knee joints were most frequently affected (36.6%), with monoarthritis being the predominant presentation.
• Only one patient tested positive for HIV, suggesting it may not be a major contributor to extraspinal tuberculous arthritis in this cohort. Synovial fluid PCR showed a high positive rate (7/11).

Conclusions:

• Extraspinal tuberculous arthritis typically manifests as chronic monoarthritis, often with a significant delay in diagnosis.
• Polymerase chain reaction (PCR) testing of synovial fluid can aid in the rapid diagnosis of tuberculous arthritis.
• HIV infection does not appear to be a primary driving factor for extraspinal tuberculous arthritis in the studied population.