Bone and joint tuberculosis: clinical manifestation, diagnostic techniques and drug resistance analysis

Clinical data on bone and joint tuberculosis (BJTB) in developing countries remain limited. This study aims to investigate the clinical, epidemiological, and drug-resistance characteristics of BJTB patients in Central China and to optimize diagnostic strategies.

This retrospective study analyzed data from patients diagnosed with BJTB at Henan Provincial Chest Hospital between 2016 and 2022.

Among the 902 patients, 518 (57.4%) were male and 384 (42.6%) were female. The age groups of 21-30 years and 51-60 years, as well as the rural population, showed the highest prevalence of cases. Local pain was the most prevalent symptom, followed by fever, night sweats, and neurological dysfunction. On average, the time from symptom onset to diagnosis was 6.1 months, and the mean hospital stay was 64.2 days. Spinal tuberculosis was the most frequently affected site, accounting for 77.6% (700/902) of cases. Five diagnostic techniques were evaluated, with GeneXpert MTB/RIF demonstrating superior performance by achieving a sensitivity of 91.6% (95%CI: 86.3%-95.0%) and specificity of 90.1% (95%CI: 85.5%-93.6%). Unlike drug resistance patterns observed in other regions, streptomycin (29.6%) and rifabutin (18.2%) were the most frequently encountered first-line and second-line anti-tuberculosis drugs, respectively. The prevalence of multidrug-resistant tuberculosis (MDR-TB) was 8.3% (95% CI: 5.1%-13.2%), and extensively drug-resistant tuberculosis (XDR-TB) was identified in 1.6% (95% CI: 0.2%-5.6%) of cases.

The application of GeneXpert MTB/RIF demonstrated significant diagnostic accuracy for BJTB. The control of MDR-TB remains a critical challenge in the management of BJTB in Central China.