Diagnosis of osteoarticular tuberculosis. A review of 120 cases managed ina rheumatology department.

The bones and joints are the fourth most common target of tuberculosis in M orocco. Objective: to review the diagnostic aspects of osteoarticular tuber culosis (OATB), particularly in extraspinal locations, in rheumatology pati ents. Patients and methods. retrospective study in patients managed between 1980 and 1994 for OATB diagnosed based on positive cultures, positive hist ology, and/or a combination of highly suggestive features. Results: 120 cas es of OATB were identified, 76 women and 44 men, with a mean age of 43+/-17 years. Twenty-three per cent of patients reported contact with a tuberculo sis patient and 10% a history of tuberculosis. Precipitating factors includ ed trauma (10.6%) and glucocorticoid therapy (12.5%). The number of foci wa s one in 76% of cases, two in 18.3%, and more than two in 5.7%, yielding a total of 159 foci in the 120 patients. Sixty-five patients had extraspinal involvement consisting in arthritis (73 foci), osteitis (six foci), and ten osynovitis (two foci). The knee was the most commonly affected joint (43 fo ci), followed by the hips (8 foci), the sacroiliac joints (8 foci), the fee t (7 foci), the shoulders (2 foci), the elbows (2 foci), and the wrist, pub is, and sternoclavicular joint (one focus each). The sedimentation rate was elevated to more than 50 mm/h in 61% of patients with extra-spinal OATB an d was normal in 10.7%. The intra-dermal tuberculin test was negative in 15. 5% of patients with extraspinal OATB. In this group, the diagnosis was base d on examination of specimens from the extraarticular focus in 46 cases or from another focus in 11 cases; in the remaining eight patients, the diagno sis was made based on a combination of highly suggestive features. All pati ents were given at least three antituberculous agents for at least six mont hs. Discussion: our data suggest that the frequency of tuberculosis is decr easing at the hip and increasing at the knee, and that tuberculous osteitis remains uncommon. Diagnostic pitfalls in extraspinal OATB are discussed an d the results of the present study are compared to previously published dat a.