Extraspinal tuberculous arthritis in HIV era

Abstract

A worldwide reemergence of tuberculosis is appreciable. Extrapulmonary tuberculosis has been observed to increase disproportionately from past incidence. One of the main attributing factors is the human immunodeficiency virus (HIV) infection. The objective of this study was to study clinical features, laboratory findings, and association with HIV infection in patients with peripheral tuberculous arthritis. The retrospective study was performed by reviewing the medical records of 27 patients with extraspinal tuberculous arthritis treated from January 1994 to December 2002. The diagnosis was made either by compatible clinical presentation and positive culture for Mycobacterium tuberculosis or histological finding of caseating granuloma in biopsy tissue or both. The average age of the patients’ population was 49.3 years (range 27–74 years), made up of a 52% or 14 patients of male subjects. The mean duration of disease before seeking medical treatment was 10.2+11 weeks and from onset to diagnosis was 25 weeks. The most frequently affected joints were knees (36.6%) followed by wrists, ankles, shoulders, hips, sacroiliacs, and elbows, respectively. Monoarthritis was the main feature of this group, except for two patients who had two and three joints involvement, respectively. Dactylitis (tenosynovitis) was also found in two out of the 27 patients. Six patients (24%) had active pulmonary infiltration on chest X-ray. Of 11 patients with synovial polymerase chain reaction (PCR) testing for tuberculosis, seven patients had positive result. Only one patient with extraspinal tuberculous arthritis tested positive for HIV. Therefore, extraspinal tuberculous arthritis is observed to be usually present with chronic monoarthritis. The diagnosis is delayed in most occasions. PCR from synovial fluid may facilitate rapid diagnosis of tuberculous arthritis. Human immunodeficiency virus may not be a main contributing factor for extraspinal tuberculous arthritis.