Tuberculosis of the Skeleton: Clinical Manifestations and Symptoms

Introduction

Skeletal tuberculosis (TB) is a rare but severe form of tuberculosis affecting bones and joints. It accounts for about 1-3% of all TB cases and is often misdiagnosed due to its insidious onset.

Pathophysiology

The disease primarily results from hematogenous spread from a primary TB focus, such as the lungs. It commonly affects the spine (Pott's disease), followed by hip, knee, and other joints.

Clinical Manifestations

• Gradual onset of localized pain and swelling
• Restricted joint movement
• Muscle wasting
• Cold abscess formation
• Neurological deficits in spinal TB

Diagnosis

Diagnostic approaches include:

• Radiographic imaging (X-rays, MRI, CT scans)
• Tuberculin skin test and Interferon-Gamma Release Assays (IGRA)
• Biopsy and histopathological examination
• Culture and polymerase chain reaction (PCR) for Mycobacterium tuberculosis

Treatment

Management consists of:

• Antitubercular therapy (ATT) for at least 6-12 months
• Surgical intervention in cases of extensive joint destruction or spinal instability
• Physical therapy for joint mobility restoration

Conclusion

Early diagnosis and appropriate treatment are crucial in preventing long-term complications associated with skeletal tuberculosis. A multidisciplinary approach involving orthopaedic surgeons and infectious disease specialists ensures optimal patient outcomes.