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Key Features

  • Infection of peripheral joints by M tuberculosis usually presents as a monoarticular arthritis lasting for weeks to months (or longer)

  • Less often, it can have an acute presentation that mimics septic arthritis

  • Any joint can be involved; the hip and knee are most commonly affected

Clinical Findings

  • Constitutional symptoms and fever are present in only a small number of cases

  • Can cause a chronic tenosynovitis of the hand and wrist

  • Joint destruction occurs far more slowly than in septic arthritis due to pyogenic organisms

  • Rarely, patients with active pulmonary or extrapulmonary tuberculous develop a reactive, sterile polyarthritis associated with erythema nodosum (Poncet disease)

Diagnosis

  • Synovial fluid is inflammatory, with synovial white cell counts in the range of 10,000–20,000 cells/mcL

  • Smears of synovial fluid are positive for acid-fast bacilli in a minority of cases

  • Synovial fluid cultures, however, are positive in 80% of cases

  • Synovial biopsy is diagnostic procedure of choice; it yields characteristic pathologic findings and positive cultures in > 90%

Treatment

Table 9–14.Characteristics of antituberculous medications.

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