Skeletal tuberculosis (TB) is uncommon. For a study, researchers sought to report on the diagnostic method and treatment of skeletal tuberculosis.

All adult patients hospitalized with microbiologically proved skeletal tuberculosis between January 2009 and December 2019 were included in the multidisciplinary single-center medical records review research. From medical records, demographic, medical history, laboratory, imaging, pathologic findings, therapy, and follow-up data were retrieved.

Among 184 TB patients, 21 (16 women, 42 years [27, 48 years]) showed skeletal involvement. Spondylitis (n=11), lytic bone lesions (n=7), sacroiliitis (n=5), arthritis (n=3), osteitis (n=2), and widespread muscle abscesses without bone lesion (n=1) were among the skeletal TB diagnoses. In most instances, lytic lesions affected both the axial and peripheral skeletons in several places. In 13 individuals, 18F-fluorodeoxyglucose positron emission tomography was used to detect multifocal asymptomatic lesions and to target biopsy. All patients received anti-TB medication for a period of 7 to 18 months. As an additional treatment, steroids were given to 15 patients (71.4%). Eleven patients required an orthopedic immobilization corset, and three required surgery. All patients improved clinically throughout therapy. However, two relapsed after a median follow-up of 24 months (12-30 months). There were no deaths or long-term impairments.

The findings highlighted the wide range of skeletal involvement in tuberculosis. Therefore, the use of an 18F-fluorodeoxyglucose positron emission tomography scanner at the time of diagnosis is critical for determining the extent of skeletal involvement and guiding extraskeletal biopsies. In addition, adding corticosteroids to anti-TB medication may help reduce neurological problems.

Reference: journals.lww.com/jclinrheum/Abstract/2022/06000/Musculoskeletal_Tuberculosis__New_Insights_on.4.aspx