Diagnostic laboratory-instrumental methods for suspicion of tuberculous arthritis, basic principles of treatment of the disease.
In case of suspicion of tuberculous arthritis, the following diagnostic tests are conducted:
- Intradermal tuberculin test (Mantoux test) - it is usually positive.
- Determination of serum antibody titers to tuberculin and other specific antigens of pathogens - mycobacterium (usually elevated).
- X-ray examination of the chest and patient's joints.
- Investigation of synovial fluid from the patient's joint (detection of the pathogen).
- Determination of mycobacteria in the urine (even in the absence of signs of tuberculous lesions of the genitourinary system).
- Multiple bacteriological study of sputum.
- Bronchoscopy with biopsy of the mucous membrane, with the study of flushing water.
- Biopsy of the synovial membrane and, according to evidence, regional lymph nodes (often tuberculosis granulomas).
- Bacteriological study of excretions of fistulas and punctates from cold abscesses.
- Ultrasound of the joints, if necessary - organs of the abdominal cavity and kidneys, retroperitoneal space, lymph nodes (on indications), pelvic organs.
- To exclude extrapulmonary tuberculosis (with indications) X-ray and endoscopic examinations of the digestive system, genitourinary system, bone and articular system (radiography of pelvic bones and spine, bacteriological examination of urine, etc.) are possible.
- Consultations of related specialists.
Treatment of tuberculous arthritis
Treatment of tuberculous arthritis, as well as any other tuberculous lesions, is carried out only by the phthisiatrician (first in a hospital, and then outpatient). The selection of special medications for complex medical treatment is strictly individual and is carried out only by a physician. Currently, it is a four-component anti-TB therapy.
If necessary, treatment is supplemented by the appointment of anti-inflammatory nonsteroidal drugs. Glucocorticoids used in other types of arthritis are strictly contraindicated.
The immobilization of the patient's joint with significant movement constraints in the acute period of the disease is shown.
With pronounced accumulation of fluid in the cavity of the joint and around the articular bags carry their puncture with aspiration (removal) of the contents.
In the case of overdue cases, in the presence of destructive changes, initially, conduct specific anti-tuberculous treatment (at least three months against the background of immobilization of the joint), and then - surgical treatment with the removal of affected and destroyed tissues and subsequent operation of arthrodeza - fixation of destroyed bone structures.
With timely initiated and sufficiently intensive therapy, 50% of patients are currently able to achieve joint restoration and its functional capabilities.