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Polyarticular septic arthritis-Do not forget tuberculosis
- Rajesh N Bankar (28 November 2006)
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Rajesh N Bankar, Specialist Registrar, Acute Medicine The Princess Royal Hospital, Haywards Heath, RH16 4EX
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Christoudoulou and colleagues have highlighted an interesting and important condition which remains under-recognised.1 Many cases of polyarticular septic arthritis are associated with rhematological disorders. And because of the underlying immunosuppressive state either due to the disease or the use of immunosuppressive drugs patients with rheumatological diseases are at high risk of developing tuberculosis (TB).2 Rarely TB can itself present with multiple joint involvement as well. Unfortunately, the diagnosis of TB-arthrits is difficult due to relative insensitivity of acid-fast staining and delay of growth in culture; and usually requires synovial biopsy.3 Early diagnosis and initiation of anti-TB chemotherapy is essential for good outcome. With the increasing incidence of TB clinicians should have a high index of suspicion;4 and be aware of TB in any patients with septic arthritis. References: 1.Christodoulou C, Gordon P, Coakley G. Polyarticular septic arthritis. BMJ 2006;333:1107-8 2.Franco-Paredes C, Diaz-Borjon A, Senger MA, Barragan L, Leonard M. The Ever-Expanding Association Between Rheumatologic Diseases and Tuberculosis. Am J Med 2006;119:470-477 3.Hortas C, Ferreiro JL, Galdo B, Arasa FJ, Barbazan C, Mera AJ, et al. Tuberculous arthritis of peripheral joints in patients with previous inflammatory rheumatic disease. Br J Rheumatol 1998;27:65-7 4.Rose AM, Watson JM, Graham C, Drobniewski F, Ormerod LP, Darbyshire JH, et al. Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998. Thorax 2001;56:173-9 Competing interests: None declared |
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