Musculoskeletal Tuberculosis: A Prospective Study

Abstract

Background: Tuberculosis of the bone and joint is undertreated in the North-East sub region of Nigeria due to lack of knowledge of the disease, especially amongst Medical Officers who treat patients in most General hospitals. Most patients treated for osteoarthritis are indeed articular tuberculosis.
Objective: To determine the incidence of this disease in our environment and proffer treatment regiments.
Methods and Design: This is a three year (2000-2003) prospective study of the patients with diagnosis of muscularskeletal TB seen UMTH. All patients had complete history and clinical examinations conducted by the teams. Investigations included X-rays, Mantoux and full blood count (FBC) and ESR. Few of the patients were also tested for HIV. Diagnosis was based on history, X-ray features of TB of the bone and joints, Mantoux, raised ESR and physical findings. Extent of the severity of disease was measured by the degree of pain, physical disability and deformity and X-ray findings. Neurological complications were treated with spinal support in addition to drug treatment. Two of our patients had spinal surgery,(decompression) when they developed spondylosis three years after treatment. Treatment was by the use of INH, Rifampicin and Pyrazinamide at the appropriate doses for the patients' ages and weights. Ethambutol was included in those with disseminated disease while anti-retroviral drugs were added for those with positive and confirmed tests. The response to treatment was assessed using ESR, clinical improvement and followed up for three to seven years.
Results: Fifty-four patients were enrolled into this study, aged 4 to 82 years. Thirty-five (64.8%) were males while 19 (35.2%) females. Forty-one (75.9%) of the patients had Pott's disease, 12 (22.2%) had TBOA, while 1 (1.9%) had Pott's disease and TBOA. Forty-four (81.5%) patients were treated with drugs alone, 8 (14.8%) had spinal support in the form of cossets or scotch cast jackets. Only 6 (11.11%) of the patients were admitted due to inability to walk because they were paraplegic. Eighty-one percent success rate was achieved using INH,Pyrazinamide(PZN) and Rifampicin for ten months. Forty-four of the patients (81.5%) got better and had no recurrence of symptoms 3-7 years of follow up. Five (9.3%) of the patients could not complete the treatment due to cost of the drugs, 1 (1.9%) relapsed and was found to be HIV positive and was lost to follow up, one (1.9%) died of PTB and HIV complications and one (1.9%) got better and was lost to follow up after the 6th month of treatment.
Conclusion: Tuberculosis of the spine, bone and joints is under diagnosed and under treated. Successful treatment can be achieved using INH, PZN and Rifampicin.

Key words: TB Spine, TB Bone and Joints, Incidence andResponse to proffered treatment.