[Osteoarticular tuberculosis today]

Abstract

The upsurge in Mycobacterium tuberculosis infection in the last 10 years has included 5 to 10% of bone and joint localizations. The AIDS epidemic has contributed considerably, but other factors appear to play a more important role. The concentration of the population and the disorganization of anti-tuberculosis campaigns have allowed the disease to flourish. Poor compliance to treatment has allowed recurrence rates to rise with the consequent risk created by the presence of chronic carriers. As demonstrated by Pertuiset et al., in this issue of La Presse Médicale the incidence of bone and joint tuberculosis is clearly higher in developing countries than in Europe. Bone and joint localizations usually result from secondary reactivation of a septic metastasis after often asymptomatic primary lung disease. Damaged articulations, particularly weight carrying joints, are preferential targets. Chronic, insidious onset in a single joint is a characteristic feature, revealed by joint pain with fever and nocturnal sweating. Acute forms are observed in transplant recipients. If treatment is initiated early enough, ad integrum cure can be achieved, but functional prognosis may be compromised if therapy is given late. In more advanced forms, surgery with drainage and debridement is required.