Background Data of musculoskeletal manifestations of tuberculosis is limited to case reports, series or retrospective study. To our knowledge there is no prospective study which has addressed this issue. So, we conducted this study to create awareness among the doctors about musculoskeletal manifestations of tuberculosis.
Objectives To study the musculoskeletal manifestations of tuberculosis.
Methods It was a prospective observational study which was conducted at a referral Tuberculosis Hospital in North India in the month of September & October 2016. Patients from outpatient and inpatient department of pulmonology were recruited irrespective of the duration of anti tubercular therapy.
We included patients who had active tuberculosis as per World Health Organization (WHO) 2010 criteria. Patients with other chronic illnesses were excluded. A detailed history, examination and appropriate investigations (blood, urine, serological and radiological) of the 100 consecutive patients fulfilling the inclusion criteria was recorded
Results Mean age of patients was 32.16±12.93 years. Male to female ratio was 43:57. Mean duration of disease was 6.85±8.83 months. Of the 100 patients, 60 (60%) had pulmonary tuberculosis. Pleural tuberculosis presenting as pleural effusion was seen in 17 (17%) patients. Abdominal tuberculosis was seen in 9 (9%), tuberculous lymphadenopathy in 8 (8%) and pott's spine in 4 (7%). Eye tuberculosis and tubercular breast lump was seen in 1 patient each.
83 (83%) patients had first episode of tuberculosis while the other 17 (17%) patients had second episode of tuberculosis. 74 (74%) patients were on category 1 anti tuberculosis treatment (ATT), while 23 (23%) were on category 2 ATT and 3 (3%) were on modified ATT. Mean duration of ATT was 1.79±1.34 months.
Fibromyalgia was classified in 21 (21%) patients, polyarthralgia's were seen in 9 (9%), pott's spine in 7 (7%), osteomyelitis in 4 (4%) and scleritis in 2 (2%) patients. Uveitis, tenosynovitis, erythema induratum, subcutaneous abscess and dactylitis was seen in 1 (1%) each. Rheumatological manifestations as septic arthritis, DILE, poncet's arthritis, tendinopathy, amyloidosis, gout, erythema nodosum and myositis were not seen in any patient.
In 21 patients who had fibromyalgia, 11 patients developed fibromyalgia with 2nd episode of tuberculosis amounting to 60.75% patients.
Conclusions This is the first prospective study to look at the musculoskeletal manifestations of tuberculosis. Patients with active tuberculosis were found to have various rheumatological manifestations.
Acknowledgements I acknowledge Dr Sushil Gupta, director of the Rajan Babu TB Hspital for allowing me to conduct this study
Disclosure of Interest None declared