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DOI: 10.1055/s-0031-1293492
Tuberculosis Arthritis and Tenosynovitis
Publication History
Publication Date:
11 November 2011 (online)

ABSTRACT
The incidence of extrapulmonary tuberculosis (TB) has been rising due to the increasing number of immunosuppressed patients. Musculoskeletal system accounts for 25% of extrapulmonary TB. Most of the musculoskeletal TB involves the spine. TB of peripheral joints and tendons occur infrequently, but if untreated, it can cause serious joint and tendon destruction as well as spread of the infection to the surrounding bursa, muscle, and other soft tissues. The diagnosis of TB of joints and tendons is difficult due to the nonspecific clinical manifestations and imaging features. Concurrent active pulmonary TB is present in <50% of the patients. A positive chest radiographic finding or a positive tuberculin test supports the diagnosis, but negative results do not exclude diagnosis. Although imaging features of TB of joints and tendons are nonspecific, certain findings such as relatively preserved joint space, juxta-articular osteoporosis, cold abscesses, para-articular soft tissue calcification, and rice bodies are suggestive of TB infection. Familiarity with these imaging features can help in making an early diagnosis and facilitating proper management.
KEYWORDS
Infective tenosynovitis - Mycobacterium tuberculosis - septic arthritis - tuberculosis - tuberculous arthritis
REFERENCES
- 1 World Health Organization. Global tuberculosis control: a short update to 2009 report. Available at: http://www.who.int/tb/publications/global_report/2009/update/en/index.html Accessed September 29, 2011
MissingFormLabel
- 2
Golden M P, Vikram H R.
Extrapulmonary tuberculosis: an overview.
Am Fam Physician.
2005;
72
(9)
1761-1768
MissingFormLabel
- 3
Gonzalez O Y, Adams G, Teeter L D, Bui T T, Musser J M, Graviss E A.
Extra-pulmonary manifestations in a large metropolitan area with a low incidence of
tuberculosis.
Int J Tuberc Lung Dis.
2003;
7
(12)
1178-1185
MissingFormLabel
- 4
Lin J N, Lai C H, Chen Y H et al..
Risk factors for extra-pulmonary tuberculosis compared to pulmonary tuberculosis.
Int J Tuberc Lung Dis.
2009;
13
(5)
620-625
MissingFormLabel
- 5
Holty J E, Gould M K, Meinke L, Keeffe E B, Ruoss S J.
Tuberculosis in liver transplant recipients: a systematic review and meta-analysis
of individual patient data.
Liver Transpl.
2009;
15
(8)
894-906
MissingFormLabel
- 6
Sayiner A, Ece T, Duman S et al..
Tuberculosis in renal transplant recipients.
Transplantation.
1999;
68
(9)
1268-1271
MissingFormLabel
- 7
Choi S W, Ahn J J, Hwang Y T, Koh S H, Cho S D.
A case of tuberculous arthritis following the use of etanercept.
Korean J Intern Med.
2009;
24
(4)
397-401
MissingFormLabel
- 8
Gardam M A, Keystone E C, Menzies R et al..
Anti-tumour necrosis factor agents and tuberculosis risk: mechanisms of action and
clinical management.
Lancet Infect Dis.
2003;
3
(3)
148-155
MissingFormLabel
- 9
Sayarlioglu M, Inanc M, Kamali S et al..
Tuberculosis in Turkish patients with systemic lupus erythematosus: increased frequency
of extrapulmonary localization.
Lupus.
2004;
13
(4)
274-278
MissingFormLabel
- 10
Kumar S, Agarwal A, Arora A.
Skeletal tuberculosis following fracture fixation. A report of five cases.
J Bone Joint Surg Am.
2006;
88
(5)
1101-1106
MissingFormLabel
- 11
Nag H L, Neogi D S, Nataraj A R, Kumar V A, Yadav C S, Singh U.
Tubercular infection after arthroscopic anterior cruciate ligament reconstruction.
Arthroscopy.
2009;
25
(2)
131-136
MissingFormLabel
- 12
Gopal K, Raj A, Rajesh M R, Prabhu S K, Geothe J.
Sternal tuberculosis after sternotomy for coronary artery bypass surgery: a case report
and review of the literature.
J Thorac Cardiovasc Surg.
2007;
133
(5)
1365-1366
MissingFormLabel
- 13
de Jong J W, van Altena R.
Non-respiratory tuberculosis with Mycobacterium tuberculosis after penetrating lesions of the skin: five case histories.
Int J Tuberc Lung Dis.
2000;
4
(12)
1184-1187
MissingFormLabel
- 14
Bryan W J, Doherty Jr J H, Sculco T P.
Tuberculosis in a rheumatoid patient. A case report.
Clin Orthop Relat Res.
1982;
(171)
206-208
MissingFormLabel
- 15
Hortas C, Ferreiro J L, Galdo B et al..
Tuberculous arthritis of peripheral joints in patients with previous inflammatory
rheumatic disease.
Br J Rheumatol.
1988;
27
(1)
65-67
MissingFormLabel
- 16
Tuli S M.
General principles of osteoarticular tuberculosis.
Clin Orthop Relat Res.
2002;
398
(398)
11-19
MissingFormLabel
- 17
Poppel M H, Lawrence L R, Jacobson H G, Stein J.
Skeletal tuberculosis: a roentgenographic survey with reconsideration of diagnostic
criteria.
Am J Roentgenol Radium Ther Nucl Med.
1953;
70
(6)
936-963
MissingFormLabel
- 18
Heycock J B, Noble T C.
Four cases of syringe-transmitted tuberculosis.
Tubercle.
1961;
42
25-27
MissingFormLabel
- 19
Noordhoek G T, van Embden J D, Kolk A H.
Reliability of nucleic acid amplification for detection of Mycobacterium tuberculosis: an international collaborative quality control study among 30 laboratories.
J Clin Microbiol.
1996;
34
(10)
2522-2525
MissingFormLabel
- 20
Moore S L, Rafii M.
Imaging of musculoskeletal and spinal tuberculosis.
Radiol Clin North Am.
2001;
39
(2)
329-342
MissingFormLabel
- 21
Madariaga M G, Jalali Z, Swindells S.
Clinical utility of interferon gamma assay in the diagnosis of tuberculosis.
J Am Board Fam Med.
2007;
20
(6)
540-547
MissingFormLabel
- 22
Song K H, Jeon J H, Park W B et al..
Usefulness of the whole-blood interferon-gamma release assay for diagnosis of extrapulmonary
tuberculosis.
Diagn Microbiol Infect Dis.
2009;
63
(2)
182-187
MissingFormLabel
- 23
Mann K J.
Lung lesions in skeletal tuberculosis; review of 500 cases.
Lancet.
1946;
2
(6430)
744-749
MissingFormLabel
- 24
Muangchan C, Nilganuwong S.
The study of clinical manifestation of osteoarticular tuberculosis in Siriraj Hospital,
Thailand.
J Med Assoc Thai.
2009;
92
(Suppl 2)
S101-S109
MissingFormLabel
- 25
Gardam M, Lim S.
Mycobacterial osteomyelitis and arthritis.
Infect Dis Clin North Am.
2005;
19
(4)
819-830
MissingFormLabel
- 26
Davies P D, Humphries M J, Byfield S P et al..
Bone and joint tuberculosis. A survey of notifications in England and Wales.
J Bone Joint Surg Br.
1984;
66
(3)
326-330
MissingFormLabel
- 27
Enarson D A, Fujii M, Nakielna E M, Grzybowski S.
Bone and joint tuberculosis: a continuing problem.
Can Med Assoc J.
1979;
120
(2)
139-145
MissingFormLabel
- 28
Valdazo J P, Perez-Ruiz F, Albarracin A et al..
Tuberculous arthritis. Report of a case with multiple joint involvement and periarticular
tuberculous abscesses.
J Rheumatol.
1990;
17
(3)
399-401
MissingFormLabel
- 29 Resnick D. Osteomyelitis, septic arthritis, and soft tissue infection: organisms. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: WB Saunders; 2002: 2510-2624
MissingFormLabel
- 30
Versfeld G A, Solomon A.
A diagnostic approach to tuberculosis of bones and joints.
J Bone Joint Surg Br.
1982;
64
(4)
446-449
MissingFormLabel
- 31
Wang M N, Chen W M, Lee K S, Chin L S, Lo W H.
Tuberculous osteomyelitis in young children.
J Pediatr Orthop.
1999;
19
(2)
151-155
MissingFormLabel
- 32
De Vuyst D, Vanhoenacker F, Gielen J, Bernaerts A, De Schepper A M.
Imaging features of musculoskeletal tuberculosis.
Eur Radiol.
2003;
13
(8)
1809-1819
MissingFormLabel
- 33
De Backer A I, Mortelé K J, Vanhoenacker F M, Parizel P M.
Imaging of extraspinal musculoskeletal tuberculosis.
Eur J Radiol.
2006;
57
(1)
119-130
MissingFormLabel
- 34 Akeson W H, Chu C R, Bugbee W. Articular cartilage: morphology, physiology, and function. In: Resnick D, ed. Diagnosis of Bone and Joint Disorders. 4th ed. Philadelphia, PA: WB Saunders; 2002: 793-815
MissingFormLabel
- 35
Popert J.
Rice-bodies, synovial debris, and joint lavage.
Br J Rheumatol.
1985;
24
(1)
1-2
MissingFormLabel
- 36
Cheung H S, Ryan L M, Kozin F, McCarty D J.
Synovial origins of rice bodies in joint fluid.
Arthritis Rheum.
1980;
23
(1)
72-76
MissingFormLabel
- 37
Popert A J, Scott D L, Wainwright A C, Walton K W, Williamson N, Chapman J H.
Frequency of occurrence, mode of development, and significance or rice bodies in rheumatoid
joints.
Ann Rheum Dis.
1982;
41
(2)
109-117
MissingFormLabel
- 38
Nagasawa H, Okada K, Senma S, Chida S, Shimada Y.
Tenosynovitis with rice body formation in a non-tuberculosis patient: a case report.
Ups J Med Sci.
2009;
114
(3)
184-188
MissingFormLabel
- 39
Muirhead D E, Johnson E H, Luis C.
A light and ultrastructural study of rice bodies recovered from a case of date thorn-induced
extra-articular synovitis.
Ultrastruct Pathol.
1998;
22
(4)
341-347
MissingFormLabel
- 40
Jaovisidha S, Chen C, Ryu K N et al..
Tuberculous tenosynovitis and bursitis: imaging findings in 21 cases.
Radiology.
1996;
201
(2)
507-513
MissingFormLabel
- 41 Davidson P T, Le H Q. Musculoskeletal tuberculosis. In: Schlossberg D, ed. Tuberculosis and Nontuberculous Mycobacterium Infections. 4th ed. Philadelphia, PA: WB Saunders; 1999: 204-220
MissingFormLabel
- 42
Dhillon M S, Nagi O N.
Tuberculosis of the foot and ankle.
Clin Orthop Relat Res.
2002;
398
(398)
107-113
MissingFormLabel
- 43
Phemister D B, Hatcher C H.
Correlation of pathological and roentgenological findings in the diagnosis of tuberculous
arthritis.
AJR Am J Roentgenol.
1933;
29
736-752
MissingFormLabel
- 44
Sawlani V, Chandra T, Mishra R N, Aggarwal A, Jain U K, Gujral R B.
MRI features of tuberculosis of peripheral joints.
Clin Radiol.
2003;
58
(10)
755-762
MissingFormLabel
- 45
Chau C L, Griffith J F.
Musculoskeletal infections: ultrasound appearances.
Clin Radiol.
2005;
60
(2)
149-159
MissingFormLabel
- 46
Pookarnjanamorakot C, Sirikulchayanonta V.
Tuberculous bursitis of the subacromial bursa.
J Shoulder Elbow Surg.
2004;
13
(1)
105-107
MissingFormLabel
- 47
Coppola J, Müller N L, Connell D G.
Computed tomography of musculoskeletal tuberculosis.
Can Assoc Radiol J.
1987;
38
(3)
199-203
MissingFormLabel
- 48
Suh J S, Lee J D, Cho J H, Kim M J, Han D Y, Cho N H.
MR imaging of tuberculous arthritis: clinical and experimental studies.
J Magn Reson Imaging.
1996;
6
(1)
185-189
MissingFormLabel
- 49
Hong S H, Kim S M, Ahn J M, Chung H W, Shin M J, Kang H S.
Tuberculous versus pyogenic arthritis: MR imaging evaluation.
Radiology.
2001;
218
(3)
848-853
MissingFormLabel
- 50
Hsu C Y, Lu H C, Shih T T.
Tuberculous infection of the wrist: MRI features.
AJR Am J Roentgenol.
2004;
183
(3)
623-628
MissingFormLabel
- 51
Shah J, Patkar D, Parikh B et al..
Tuberculosis of the sternum and clavicle: imaging findings in 15 patients.
Skeletal Radiol.
2000;
29
(8)
447-453
MissingFormLabel
- 52
Batra S, Ab Naell M, Barwick C, Kanvinde R.
Tuberculous pyomyositis of the thigh masquerading as malignancy with concomitant tuberculous
flexor tenosynovitis and dactylitis of the hand.
Singapore Med J.
2007;
48
(11)
1042-1046
MissingFormLabel
- 53
Soler R, Rodríguez E, Remuiñán C, Santos M.
MRI of musculoskeletal extraspinal tuberculosis.
J Comput Assist Tomogr.
2001;
25
(2)
177-183
MissingFormLabel
- 54
Faure E, Souilamas R, Riquet M et al..
Cold abscess of the chest wall: a surgical entity?.
Ann Thorac Surg.
1998;
66
(4)
1174-1178
MissingFormLabel
- 55
Morris B S, Maheshwari M, Chalwa A.
Chest wall tuberculosis: a review of CT appearances.
Br J Radiol.
2004;
77
(917)
449-457
MissingFormLabel
- 56
Kuzucu A, Soysal O, Günen H.
The role of surgery in chest wall tuberculosis.
Interact Cardiovasc Thorac Surg.
2004;
3
(1)
99-103
MissingFormLabel
- 57
Paik H C, Chung K Y, Kang J H, Maeng D H.
Surgical treatment of tuberculous cold abscess of the chest wall.
Yonsei Med J.
2002;
43
(3)
309-314
MissingFormLabel
- 58
Chung S Y, Yang I, Bae S H et al..
Tuberculous abscess in retromammary region: CT findings.
J Comput Assist Tomogr.
1996;
20
(5)
766-769
MissingFormLabel
- 59
Teo T H, Ho G H, Chaturverdi A, Khoo B K.
Tuberculosis of the chest wall: unusual presentation as a breast lump.
Singapore Med J.
2009;
50
(3)
e97-e99
MissingFormLabel
- 60
Khalil A, Le Breton C, Tassart M, Korzec J, Bigot J, Carette M.
Utility of CT scan for the diagnosis of chest wall tuberculosis.
Eur Radiol.
1999;
9
(8)
1638-1642
MissingFormLabel
- 61
Supe A N, Prabhu R Y, Priya H.
Role of computed tomography in the diagnosis of rib and lung involvement in tuberculous
retromammary abscesses.
Skeletal Radiol.
2002;
31
(2)
96-98
MissingFormLabel
- 62
Choi J A, Koh S H, Hong S H, Koh Y H, Choi J Y, Kang H S.
Rheumatoid arthritis and tuberculous arthritis: differentiating MRI features.
AJR Am J Roentgenol.
2009;
193
(5)
1347-1353
MissingFormLabel
- 63
Zacharia T T, Shah J R, Patkar D, Kale H, Sindhwani V.
MRI in ankle tuberculosis: review of 14 cases.
Australas Radiol.
2003;
47
(1)
11-16
MissingFormLabel
- 64
Hassanpour S E, Gousheh J.
Mycobacterium tuberculosis-induced carpal tunnel syndrome: management and follow-up evaluation.
J Hand Surg Am.
2006;
31
(4)
575-579
MissingFormLabel
Nuttaya PattamapaspongM.D.
Department of Radiology, Faculty of Medicine, Chiang Mai University
110 Intavaroros Road, Chiang Mai 50200, Thailand
Email: nuttaya@gmail.com