A retrospective case series: Bone and joint TB in North East London

Abstract

Accounting for 5% of all tuberculosis (TB), osteoarticular involvement is uncommon. Accompanied by no clear evidence of focal pathology on initial imaging, early diagnosis can be difficult. We have completed a case series looking at patients with tuberculous arthritis and osteomyelitis in North East London to assess for any identifiable risk factors to assist earlier diagnosis. A retrospective study was performed of patients diagnosed with tuberculous arthritis and osteomyelitis (excluding spinal TB) across Newham, Whipps Cross and Mile End Hospitals in London between 2005 and 2015 using London TB Records and local records. Data was recorded for demographics, clinical symptoms, diagnostic investigations including microbiology and histology as well as treatment outcomes for each patient. 147 cases of bone and joint TB were identified across 9 anatomical categories of which the knee was the most commonly affected joint (21%). 109 (74%) were male with an age range of 12–89 years (median 31, interquartile range 24-42). 126 patients were born outside the United Kingdom with Bangladesh being the highest country of birth in 37 cases. The average stay in UK at time of presentation is 10 years. 24 patients were smear-positive and 53 were culture positive only. 5 were monoresistant (4 to isoniazid, 1 to pyrazinamide). 48 patients were found to have co-current TB but only 40 of the total cohort were documented to have constitutional symptoms. 125 patients completed treatment with 5 having joint replacement. Migrants who present with joint swelling should be assessed fully for TB irrespective of length of stay in the UK and a low threshold for early referral to a TB specialist should be considered.