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OBJECTIVE: to determine a list of anti-tuberculosis drugs (ATDs) for local therapy of destructive tuberculous arthritis (TA) as part of a cement spacer at the first stage of surgical treatment. Relevance: TA accounts for up to 15% of all cases of tuberculosis of the osteoarticular system, its prevalence increases with immunodeficiency/HIV. The effectiveness of treatment depends, among other things, on the rational technique of antimicrobial chemotherapy and is no more than 75%. MATERIALS-METHODS: In vitro studies were conducted to study the elution and antimycobacterial characteristics of the drugs: I (H), R, E, Cs, Am, Сар, Lzd, Lfx, Bq, loaded into bone cement, which is used to make a joint spacer at the first stage of surgical treatment.The elution characteristics of ATDs were determined using spectrophotometry and high-performance liquid chromatography.Antimycobacterial properties were studied against the drug-susceptible control strain Mycobacterium tuberculosis H₃₇ Rv. RESULTS: The experimental studies carried out made it possible to determine a list of ATDs for use in cement spacers. It was revealed that the necessary characteristics among the studied drugs for use in cement spacers correspond to Lzd, Сар, Am, Cs, I (H), as well as R for a certain spacer design. The data obtained made it possible to perform personal preoperative planning with the selection of an ATDs taking into account the sensitivity of the pathogen for use in the spacer, and to create an effective concentration of ATDs in the area of inflammation during at the first stage of surgical treatment.

Tuberculosis is a chronic infectious disease, caused by Mycobacterium tuberculosis, that seriously endangers human health. Skeletal tuberculosis is the most common type of extrapulmonary tuberculosis and tuberculous arthritis is the second most common type of skeletal tuberculosis. We report a case series of patients with tuberculous arthritis, two of whom had no joint disease in the past and presented as monoarthritis. The final patient had a history of rheumatoid arthritis, with polyarthritis that was aggravated during treatment with glucocorticoids and immunosuppressive drugs. This series of cases can contribute to early diagnosis and treatment with appropriate infection control measures.

A 68-year-old-gentleman presented with left hip pain, night sweats, fatigue, and weight loss. He had previously experienced pain with white discharge until he underwent an arthroscopic washout and reduction. The left lower limb was shortened and wasted with limited hip movements. He had recently travelled to Zambia, his country of origin. Imaging demonstrated a large mass with chronic erosions of the acetabulum and femoral head. Synovial biopsy grew Mycobacterium tuberculosis, which was treated with rifampicin, isoniazid, pyrazinamide, and ethambutol for 2 months then 4 months of rifampicin and isoniazid. Whole genome sequencing indicated full sensitivity. Complex reconstructive surgery is scheduled, with a custom femoral head and acetabulum. This case illustrates the importance of considering tuberculosis in patients with erosive joint pathology and a multidisciplinary approach as delayed diagnosis results in high morbidity. Prompt diagnosis using newer modalities such as whole genome sequencing on synovial fluid can enable timely treatment.

Introduction: Skeletal tuberculosis (TB) accounts for about 10 to 35% of extrapulmonary cases and the knee is the most frequent site after the spine and hip. The diagnosis is difficult and largely clinical. Case presentation: This is a case of a young Pakistani man with a history of joint pain for about 4 years, who was diagnosed with chronic arthritis of the right knee. Microscopy of synovial fluid and conventional diagnostic tests to identify Mycobacterium tuberculosis were negative, while a non-classical method based on intracellular cytokine flow cytometry response of CD4 T-cells in synovial fluid helped us to address the diagnosis, which was subsequently confirmed by Polymerase Chain Reaction (PCR). Conclusions: Thanks to an innovative immunological approach, supported by PCR for detection of M. tuberculosis DNA, we were able to diagnose tuberculous arthritis of the knee, which allowed prompt initiation of treatment to reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

Tuberculosis is known to be a great mimicker, and it can present in a myriad of ways, which often result in an incorrect diagnosis. In a country that is endemic to tuberculosis, the presentation can take many forms ranging from tumour to trauma. We present a case of Baker’s cyst that was provisionally diagnosed as pigmented villonodular synovitis (PVNS) of the knee and eventually turned out to be tuberculous arthritis. A 46-year-old male presented with an insidious swelling on the posterior aspect of his knee for one year. Magnetic resonance imaging was suggestive of PVNS as the likely diagnosis. The patient presented 21 days later with a foot drop. On following-up with further investigations, he was found to have a lesion at the level of the L4-L5 spine. Chest radiograph changes were suggestive of tuberculosis. A synovial biopsy of the knee was done, and the tuberculosis culture report was positive. The patient was started on anti-tubercular treatment and then operated on, with arthroscopic synovectomy and posterior open cyst excision. The histology report was positive for tuberculous synovitis. The patient completed the course of anti- tubercular drugs and had physiotherapy. He demonstrated a clinically and radiologically healed disease at the final follow-up with a good functional outcome. Clinicians must have a high index of suspicion for tuberculosis, especially in endemic areas. Getting a chest radiograph is recommended in every case. Early diagnosis with the appropriate treatment will give a good functional outcome for the patient.

Tuberculosis (TB) is a respiratory disease that primarily affects the lungs. The challenge is to recognize the characteristic of TB disease, including extrapulmonary presentation. TB arthritis is an extrapulmonary TB presentation in the joint, which is frequently neglected and misdiagnosed. A 41-year-old female patient was presented with a major complaint of chronic pain in her left wrist for three months. The patient had a low-grade fever without respiratory symptoms. Local examination revealed swelling, warmth and tenderness. Erythrocyte sedimentation rate (ESR) was increased and chest radiograph demonstrated pulmonary TB. She underwent arthrotomy debridement and culture examination. We initiated adjuvant anti-tuberculous treatment. On the evaluation, she reported relief from pain and showed improvement in general condition. TB arthritis is unique due to its rare incidence and unspecific clinical manifestations. A better understanding of these issues will prevent possible diagnostic errors. Prompt treatment was crucial to maintain joint function and prevent permanent destruction.

Background: Infectious (septic) Arthritis in immunocompromised (HIV/AIDS) patients can lead to mortality if not diagnosed early and treated properly. The incidence of this condition across the globe is wide and varied. There is paucity of epidemiologic data in our environment. Objectives: The purpose of this study was therefore to evaluate the prevalence and pattern of presentation of infectious (septic) arthritis in our local environment and compare it with the global trend. Materials and Methods: Blood samples from 360 HIV/AIDS patients aged 19 to 67years suspected to have infectious (septic) arthritis were analyzed for Full blood count, ESR, CD4 count, and blood culture. Synovial fluid from the involved joint was analyzed for white cell count, microscopy culture and sensitivity, and assay for tuberculosis using the ZN stain technique. Mantoux test was done in those suspected to have tuberculous arthritis. Data were analysed using SPSS version 25. Results: Sixteen of the 360 participants had infectious (septic) arthritis involving twenty joints of the appendicular skeleton, and three spinal involvements. 50% of these had acute septic arthritis, 25% had HIV associated arthritis, 12.5% had tuberculosis of the spine, while 6.25% each had tuberculous arthritis, and tuberculous arthritis coexisting with tuberculosis of the spine. 62.5% had staphylococcus aureus, 25% streptococcus pyogenes, while 12.5% were Klebsiella Species. ZN stain was positive in two cases. Conclusion: The prevalence of infectious (septic) arthritis in HIV/AIDS immunocompromised patients in our environment was 4.4%. Acute septic arthritis was commonest infectious arthritis in this group of patients with Staphylococcus aureus being the commonest organism isolated. The knee joint was the most commonly affected joint. [ABSTRACT FROM AUTHOR]

Tuberculosis is one of the major health problems in developing countries affecting different organs such as bone and joints. One of the most important involvements of osteoarticular tuberculosis is that of the sacroiliac joint. In addition, its incidence has increased over the past several years. Early diagnosis is necessary to prevent further disorders such as neurological and surgical complications. We report a tuberculous arthritis case in the right sacroiliac joint, which developed after penicillin injection. The patient was a 32-year-old man admitted to Besat hospital, Tehran, Iran. He complained of pain, erythema and swelling in his right buttock starting approximately 17 years previously, after a penicillin injection, which was followed by the emergence of an orifice with yellow secretions. Over the years, the secretions continued but the pain, swelling and erythema were resolved. At the time of admission, his vital signs were stable and normal. In the physical examination, an orifice with a small amount of yellow secretion was detected on the right buttock as claimed by the patient. Lung auscultation was clear. No lymphadenopathy was detected. Laboratory data were normal. During hospitalization, initial antibiotic therapy was prescribed. After Mycobacterium tuberculosis was detected in culture, a 4-drug anti-TB therapy encompassing rifampin, isoniazid, ethambutol and pyrazinamide was prescribed for 18–24 months, in addition to daily vitamin B6 and pantoprazole.

Tuberculosis (TB) remains endemic in South Africa. The spine, hip, and knee joints are common extra-pulmonary TB sites. Sound history taking, clinical examination, and basic laboratory and pathological tests remain key important steps in osteoarticular TB diagnosis. In our resources-stricken context cost is everything, if we can make a diagnosis cheaply that would go a long way. The diagnostic yield of standard laboratory tests compared to a real-time polymerase chain reaction (PCR) for osteoarticular TB diagnosis in a single orthopaedic unit has not been analysed. We conducted a retrospective record review of extra-spinal osteoarticular TB infection at our hospital from 01 June 2016 to 31 December 2021. Patient demographics, clinical history, and laboratory test results were analysed. A total of 34 cases were identified, with 32 of the cases being articular and two osseous involvement. The knee was the most common joint affected followed hip joint. Acid Fast Bacilli were detected in 32% of cases with microscopy, while TB culture was positive in 29% of samples. Histopathological examination and real-time PCR diagnosed TB in 66% and 63% of the cases, respectively. Our findings suggest that in the right context of a suggestive history and examination, histological analysis is as good as PCR for diagnosing osteoarticular TB., Competing Interests: No conflict of interest or disclosures to be made by all authors.

• The involvement of the wrist in the tuberculous arthritis is very rare. • Tuberculous arthritis of the wrist can cause great morbidity. • Rheumatoid arthritis can mimick tuberculous arthritis. • Tuberculous arthritis of the wrist can be successfully treated with debridement and synovectomy. Mycobacterium tuberculosis causes infection in approximately one-third of the world's population. Arthritis due to Mycobacteriurn tuberculosis usually presents as a chronic, slowly progressive, monoarticular infection that predominantly involves the weight-bearing joints and the spine. The hand and wrist are rare sites for tuberculosis (TB) and comprises of < 1% of all skeletal TB. Even though it is rare, TB of the wrist is a cause of great morbidity. We presented a case of wrist TB treated with debridement and synovectomy. A 35 years old woman came with the chief complaint of pain and swelling on the right wrist since 1 year ago and was diagnosed with rheumatoid arthritis of the wrist. Patient then was given methylprednisolone 4 mg twice a day and methotrexate 175 mg once a week. However, the pain and swelling of her right wrist became worse. Subsequently patient was admitted to hospital and laboratory findings suggested a tuberculous arthritis of the wrist. Debridement, synovectomy, and biopsy, in addition to antituberculosis therapy, were then performed. Tuberculous arthritis is generally a monoarticular disease that typically involves the spine or large and medium-sized joints. Rheumatoid arthritis (RA) and tuberculous arthritis may have similar clinical characteristics, which consists of a chronic course with periarticular soft-tissue swelling. Tuberculous arthritis and RA can have similar characteristic but laboratory examination can help in establishing diagnosis. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis complex (MTBC). Pulmonary TB is the most common form of presentation, but extrapulmonary tuberculosis (EPTB) contributes significantly to morbidity and mortality. Rarely, patients with EPTB develop a form of ankle or foot arthritis. The diagnosis of TB arthritis is often overlooked because of the insidious onset and the non-specific clinical symptoms. Prognosis is generally poor; early diagnosis and delivery of the most appropriate treatment is critical to avoid functional disability.

Purpose: The purpose of this study was to suggest a multimodal diagnostic approach to determine the cause of the disease in patients diagnosed with synovitis of the wrist and who underwent synovectomy. Materials and Methods: Twenty-nine patients, who underwent contrast magnetic resonance imaging (MRI) preoperatively and synovectomy from January 2000 to December 2013, were reviewed retrospectively. Among them, 17 patients underwent a Tc99m white blood cell (WBC) scan preoperatively. In patients who met the diagnostic criteria of rheumatoid arthritis (RA), the diagnosis was confirmed as RA if the MRI finding or histology was compatible with RA. If the MRI finding and histology were disparate, the final diagnosis was made based on the histologic finding. Results: Of the nine patients who met the diagnostic criteria of RA, seven patients were finally diagnosed as RA and two patients as tuberculous arthritis. Of the 20 patients who did not meet the diagnostic criteria of RA, the MRI findings and histology were consistent with the same disease in 12 patients. In the remaining eight patients, five were diagnosed with nonspecific chronic synovitis, one with RA, and two with tuberculous arthritis based on the clinical findings, MRI, and histology findings. Conclusion: MRI and a WBC scan are very useful imaging modalities for diagnosing the causative condition of the wrist synovitis. A histology evaluation after synovectomy can also be useful in cases with a difficult diagnosis or are refractory to medications. [ABSTRACT FROM AUTHOR]

Skeletal tuberculosis accounts for around 10 percent of cases of extrapulmonary tuberculosis. Hip and knee involvement are the most commonly affected sites after spine. Clinical manifestations include swelling, pain, and loss of joint function that progress over weeks to months. In the setting of tuberculous arthritis, local soft tissue swelling, osteopenia, and bone destruction (with relative preservation of cartilage space) occur early in the disease. Subsequent findings include structural collapse, sclerotic changes, and soft tissue calcification. Delay in diagnosing tuberculous arthritis can lead to functional disability and poor outcome. Superimposed infection with another organism occurs very rarely and can lead to delay in diagnosing the condition. We present a case of tuberculous knee arthritis that was superimposed with Staphylococcus aureus infection. The low index of suspicion at the initial presentation together with the superimposed infection led to a delayed diagnosis. Our patient’s risk factor was immigration from a country endemic with tuberculosis. The case was diagnosed 32 months from initial presentation. In the presence of clinical and epidemiological risk for tuberculous arthritis, requesting the appropriate tests is crucial to avoid any diagnostic delay. [ABSTRACT FROM AUTHOR]

Elbow tuberculosis is a rare disease which accounts for 1-3% of all cases of osteoarticular tuberculosis. The diagnosis of tuberculous arthritis is very difficult in most clinical situations because of the insidious onset, indolent process, and mild and non-specific local or systemic symptoms. Thus, the confirmatory diagnosis and effective treatment for tuberculous arthritis are delayed until the disease progresses to an advanced stage in many clinical settings. Herein we report a case of septic arthritis of the elbow due to Mycobacterium tuberculosis as a result of misdiagnosis and delayed treatments.

Several methods for obtaining knee arthrodesis have been described in the literature and world; over, the commonest cause for arthrodesis is a failed arthroplasty. Less commonly, as in this series, post-infective or traumatic causes may also require a knee fusion wherein arthroplasty may not be indicated. We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator. All patients went on develop fusion at an average of 5.4 months with an average limb length discrepancy of 3 cm (1.5-6 cm). Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000). Knee arthrodesis with a single monorail external fixator is a reasonable single-staged salvage option in patients wherein arthroplasty may not be the ideal choice. The outcome, though far from ideal, is definitely positive and predictable. [ABSTRACT FROM AUTHOR]

When it comes to cancer, one can expect the unexpected. The clinical presentations can be very bizarre. One of these uncommon presentations is monoarticular arthritis. The age group affected by cancer and arthritis are similar. However, the possibility of joint pain being secondary to metastatic involvement does not come to mind easily. In this report, a 65-year-old postmenopausal woman presented with complaint of pain and restricted movement of the right knee joint, in whom the clinical and magnetic resonance imaging features were suggestive of infective monoarthritis. However, synovial fluid aspirate showed presence of malignant cells. Hence, patient was evaluated with whole-body 18F-fluorodeoxyglucose positron emission tomography computed tomography which detected primary malignancy of the cervix with regional nodal and right knee joint metastasis. To our knowledge, this is the first reported case of cervical malignancy with solitary skeletal metastasis involving the knee joint. The report also discusses overall incidence of malignant arthritis. [ABSTRACT FROM AUTHOR]

The risk of active tuberculosis (TB) is increased in patients with systemic autoimmune diseases, the more so in those with severe organ/system involvement and high disease activity, requiring aggressive immunosuppressive treatment. In the following paper we are presenting the case of a female systemic lupus erythematosus (SLE) patient with WHO class IV lupus nephritis and a history of completely healed miliary TB, who developed tuberculous arthritis of the knee. Promptly diagnosed and treated by associating chemotherapy for TB with a large synovectomy, the outcome of the arthritis was favorable. To present, this patient's SLE has been in remission for 3 years, with minimal renal impairment, while the TB arthritis is cured without any significant disability. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to determine the epidemiological and clinical characteristics, coexisting conditions, causative organisms, and outcomes of all adult patients 15 years of age or older who had definite septic arthritis at Hamad General Hospital, Qatar, from 2006 to 2011. During this period, 56 patients were diagnosed with septic arthritis (mean age ± SD, 49.0 ± 16.6 years). In 53 of 56 (94.6 %) patients, arthritis was diagnosed in a single joint, while polyarthritis was diagnosed in 3 of 56 (5.4 %) patients; the most commonly involved joint was the knee (40 of 59 joints, 67.7 %). The most frequent coexisting condition was diabetes mellitus (24 of 56 patients, 42.8 %). Joint pain and restriction of movement were reported by all patients. Gram-positive bacteria accounted for 36 of all 57 (63.0 %) isolated microorganisms, and Staphylococcus aureus was the most common pathogen (20 of 57 microorganisms, 35.0 %). Three cases of tuberculous arthritis were seen. The most favored antibiotic combinations were cloxacillin/ciprofloxacin, cefazolin/ciprofloxacin, and vancomycin/ciprofloxacin. Repeated needle aspiration, open joint drainage, and arthroscopic techniques were performed in 18 (32.1 %), 22 (39.3 %), and 11 (19.6 %) of the 56 patients, respectively. The 30-day mortality was 3.6 %, and the remaining patients showed clinical improvement upon discharge. In conclusion, there was no specific sign or symptom for diagnosing septic arthritis. Isolation of bacteria from the synovial fluid confirmed the diagnosis, and S. aureus and streptococci were the most common pathogens isolated. Prompt treatment with appropriate antibiotics and synovial drainage are mandatory to improve the outcome. [ABSTRACT FROM AUTHOR]

Tuberculous arthritis is difficult to diagnose early because of its atypical insidious clinical manifestations and non-specific imaging findings. Specifically, monoarticular tuberculosis of the knee may mimic pigmented villonodular synovitis (PVNS). The present report describes a young patient with tuberculous arthritis of the knee. Proper diagnosis was delayed due to magnetic resonance imaging findings, such as hemosiderin deposits and a nodular mass around the knee joint, suggesting the diffuse type of PVNS. These findings suggest that the first step in the diagnosis of tuberculous knee arthritis is to have a high index of suspicion. Level of evidence IV. [ABSTRACT FROM AUTHOR]

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, paraarticular 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. [ABSTRACT FROM AUTHOR]

Abstract: Tuberculosis of the ankle is an uncommon presentation of extrapulmo-nary infection. The early diagnosis of tuberculous arthritis of the ankle is difficult because of the uncommon site, the ability of tuberculosis to mimic other disorders and, all too common, lack of awareness of this infection by the physician. Here, we report the case of a 14-year-old boy with an unusual presentation of tuberculous arthritis involving the ankle joint. The patient, despite a period of conservative treatment, presented with a localized painful swelling of the ankle associated with recurrent ankle sprain. Tuberculous arthritis was diagnosed through a surgical procedure, and antituberculous therapy eventually eradicated the infection. It is highly recommended that early open biopsy and synovial fluid culture be performed in suspicious cases because early diagnosis is the key to successful treatment. [ABSTRACT FROM AUTHOR]