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

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).

CONCLUSIONS

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.