Bone and Joint Tuberculosis in Imam Khomeini Hospital Tehran, 1372-1375

ABSTRACT Tuberculosis is a major health problem in the world, which causes considerable mortality and morbidity. In a prospective - descriptive study, a group of patients with diagnosis of bone and joint tuberculosis on the basis of the clinical symptoms, signs and paraclinical data with positive PPD and negative Wright tests, were examined in Imam Khomeini Hospital (Infectious Disease and Orthopedic Departments) from the clinical, microbiologic and therapeutical points of view. From 481 patients who was treating for tuberculosis, 13% had the above conditions. The age of the most was between 10 -27 (min. 12 and max. 87 years). Complains, were often vague and mild and less attracts attention of the patiant or physician. Besides prolonged Low Back Pain, there were tolerable pain and joints movement limitation (first knee, then thigh). There were systemic signs as night sweats, fever and weight loss, which seemed unimportant. There were 65% colapse between two vertebrae, %6 of cases had multiple involvment of the skeleton and %11 of them had local fistulas. The duration of the illness (as mentioned by the symptoms) was mostly about 6 months or less. 66% had granuloma, showing a central area of caseation, epitheliod cells, lymphocytes and multinucleate giant cells in synovial biopsies of the joints and only one case had positive biopsy culture of the synovium for Mycobacterium Tuberculosis. X-Rays revealed nonspecific findings with no paranchymal involement in Chest X-Rays. None needed surgery. As tubercolosis is endemic in Iran and regarding 12 months prescriled chemotherapy for our patients, despite their irregular and uncomplete consult (56% of patients had only one cosult) and as a few patients who consult regulary feel better and their signs and X-Rays improved. We may consider bone and joint tuberculosis, when there is a strong evidenace, as regards other possibilities and start the medical management.