Tuberculosis of bones
3-5% of people with lung disease have tuberculosis of the bones and joints. In children and adolescents, the musculoskeletal system suffers much more frequently, and the disease itself has a more severe course.
With tuberculosis, almost any part of the skeleton can be affected. In half of the patients, the spinal column is always involved in the pathological process. This is due to its location near the lungs. As for the hip, knee and other large joints, with tuberculosis they suffer a little less frequently than the vertebrae. Zygomatic bones, upper and lower jaw, hands and feet are even less affected.
Causes and mechanism of development of pathology.
Joint and bone tuberculosis is an infectious disease. It develops due to the hematogenous spread of mycobacteria throughout the body. With blood flow, pathogenic microorganisms can enter almost any part of the body. Having penetrated the spongy substance of the bones, they cause the development of a specific inflammatory process there. Specific inflammation has a severe course and distinctive features. It develops in people infected with a certain pathogen. Mycobacteria of leprosy and tuberculosis, pale treponema, and some other microorganisms can cause specific inflammation.
In adults, bone tuberculosis usually develops against a pulmonary background. Koch’s rods enter the systemic circulation from the lungs and from there into the bone tissue. The musculoskeletal system is not affected immediately, but only with a prolonged course of the disease. Alarming symptoms appear quite early, making it easy to suspect and diagnose pathology. In childhood, the disease is usually a complication of vaccination. The blood-containing vaccine strain of mycobacteria is transported throughout the body, leading to the development of post-vaccination BCG osteoplasty. The disease has poor symptoms and is characterized by massive bone destruction in a context of good general condition of the child. Stages of development of osteoarticular tuberculosis:
The formation of ankylosis.
At first, only the spongy substance in the bones is involved in the pathological process. It forms tuberculous granulomas and encapsulated sequestration. In the future, a person develops tuberculosis arthritis. The articular cartilage is destroyed and the serous-fibrinous effusion accumulates in the synovial cavities. In case of rupture of the joint capsule, external fistulas are formed. As a result, the joint cavity is cleared, leading to a complete loss of its functions. Specific changes can also be detected in regional and lymph nodes with osteoarticular tuberculosis. Paraspecific reactions are detected in the vascular walls, myocardium, and joints in some patients.
In children, spondylitis is most often diagnosed at the age of 2-4 years, causing damage to the upper extremities at 4-7 years at 15-18 years.
Symptoms of tuberculosis of the bones and joints
The disease is characterized by symptoms of general intoxication and local signs of skeletal damage. The former include sleep disorders, loss of appetite, periodic jumps in body temperature, and autonomic disorders. Intoxication phenomena are more pronounced in children and often absent in adults.
Heel pain may be the first symptom of tuberculosis of the bones and joints. This is due to the early development of the pathological process in the calcaneus due to the great load on it during the walk.
Signs of Spinal Tuberculosis
At first, a person is concerned with constant fatigue, general weakness, and nighttime back pain. Over time, the pain increases and begins to radiate to other parts of the body. In case of damage to the cervical spine, the pain spreads to the neck and suprascapular region, chest, abdomen, and thorax, lumbosacral, lower extremities.
Even “neglected” joint problems can be cured at home! Just remember to smear it once a day. For pathology, the following symptoms are characteristic:
back muscle tension;
incorrect forced posture;
sharp back pain during exertion;
palpation pain of the spinous processes of the vertebrae.
In the later stages, spinal tuberculosis may be accompanied by the formation of “cold abscesses.” They are most often found on the back of the head, neck, hips, buttocks, and iliac region. Such abscesses do not cause symptoms of acute inflammation (pain, fever, increased local temperature, and redness of the skin).
Tuberculosis of the spine often leads to serious complications. These include pressure ulcers, disorders of pelvic organ function, paresis, and paralysis of the muscles of the lower extremities.
Symptoms of tuberculosis in the knee
The first sign of pathology is constant pain in the knee, which is intensified by walking, bending and bending the leg, feeling the joint. The periarticular tissues swell and densify. Over time, symptoms become more pronounced.
As the disease progresses, the person atrophies the muscles and develops limb flexion contracture. Because of this, it becomes extremely difficult for him to straighten his leg at the knee. In the later stages, fistulas and abscesses may form in the periarticular tissues. With secondary infection of the joint, the patient may develop acute arthritis.
Symptoms of Hip Tuberculosis
It manifests itself in pain in TBS, which intensifies over time. Soon, it becomes difficult for the patient to walk and perform the usual actions. With tuberculosis of the hip joint, edema of periarticular tissues increases slowly, without fever and acute pain. Mild swelling can be detected only by careful examination or palpation.
Signs of damage to the maxillofacial region
The bones of the skull and face suffer extremely rarely – in only 1-2% of cases. Tuberculous granulomas are localized subperiosteally. Pathology is characterized by the presence of small rounded formations, painless or slightly painful on palpation. The skin above them usually remains unchanged. Subsequently, abscesses form in the bones, which are manifested by swelling and fluctuation. Over time, they open up with the formation of external fistulas. In case of damage to the bones of the skull, abscesses can break into the cavity of the skull. Fortunately, the dura mater acts as a reliable barrier to the spread of the tuberculosis process.
Methods for the diagnosis of tuberculosis of bones and joints
In people with pulmonary tuberculosis, doctors detect the disease easily. They use radiography, CT, or MRI to confirm the diagnosis. Detection of mycobacteria in a biopsy or purulent discharge from fistula also has important diagnostic value.
In people who are not registered with the TB dispensary, doctors are not always able to suspect tuberculosis of the joints. They confuse the disease with chronic arthritis or osteoarthritis. Therefore, physicians should pay special attention to people at risk for tuberculosis who complain of constant pain in the back and limbs.
Osteoarticular tuberculosis can be confused with syphilis, actinomycosis, osteomyelitis, chronic arthritis, malignant neoplasms or other diseases. Doctors can make the correct diagnosis only after examination.
General principles of treatment
First of all, special anti-TB drugs are prescribed to the patient. They are selected strictly individually. In some people, doctors can detect resistant forms of tuberculosis that do not respond to most modern medicines. Fighting them is especially hard.
In the presence of large sequesters, abscesses and fistulous passages, patients are recommended surgical intervention. Surgeons excise pathological formations and wash the wounds with antibiotic solutions. In the late period, if necessary, the patient is performed reconstructive surgery. If you or your child have symptoms of joint tuberculosis, contact a TB dispensary for help. They will examine you, register you and provide assistance.