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Volume 40, Number 6, December 2007

Tuberculous arthritis — a fourteen-year experience at a tertiary teaching hospital in Taiwan


Tsung-Yu Huang, Ting-Shu Wu, Chien-Chang Yang, Ping-Cherng Chiang, Kuang-Hui Yu, Ming-Hsun Lee
Divisions of 1Infectious Diseases and 2Rheumatology and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan

Received: May 8, 2005    Revised: June 30, 2006    Accepted: August 18, 2006   

 

Corresponding author:

Dr. Ming-Hsun Lee, Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, 5 Fu-Shin St., Kweishan 333, Taoyuan, Taiwan. E-mail: Dr. Ming-Hsun Lee This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

To characterize the clinical and microbiological features of tuberculous arthritis and to clarify the factors affecting treatment outcome.

 



 

Methods:

We retrospectively reviewed 51 adult patients with a diagnosis of tuberculous arthritis at Chang Gung Memorial Hospital-Linkou over a 14-year period.

 



 

Results:

There were 35 males and 16 females with a mean age of 58.9 years (range, 32 to 89 years). The mean duration of symptoms and signs before diagnosis was 25.4 months (range, 0.25 to 180 months). Joint pain (96.1%) and swelling (90.2%) were two major presentations. Forty five (88.2%) patients had monoarthritis. Knee (26.7%) was the most frequently involved one. Twenty six (51.0%) patients had roentgenologic evidence of pulmonary tuberculosis (TB). Forty three patients (84.3%) had positive TB culture of synovial fluid and/or tissue. Of which, 27 (63%) had positive acid-fast bacillus smear. Twenty five patients had sputum for mycobacterial smear and culture, and 17 of them had positive TB culture. Thirty six patients received post-treatment follow-up for 3 to 110 months. Among them, 8 had relapses and 28 had treatment success. Compared the relapse to the success, the former had a higher ratio of drug resistant strains (odds ratio, 7.8; 95% confidence interval, 1.025-59.337; p=0.047) and had a longer treatment duration (22.0 ± 4.4 vs 13.2 ± 4.1 months; p=0.001).

 



 

Conclusion:

Tuberculous arthritis often occurred in elderly people with male predominance. Drug resistant strain may cause a relapse of tuberculous arthritis, which may result in longer treatment duration. Routine chest X-ray and sputum for mycobacterial smear and culture could be necessary to find concurrent pulmonary TB.

 



 

Key words:

Antitubercular agents; Drug resistance, bacterial; Treatment outcome; Tuberculosis, osteoarticular pathology


 



 

J Microbiol Immunol Infect. 2007;40:493-499.