Bone Tuberculosis: Causes, Symptoms, and Treatment

Bone tuberculosis (TB) is a disease that historically plagued communities and continues to pose challenges in modern healthcare. Bone TB, caused by Mycobacterium tuberculosis, affects the skeletal system and can lead to debilitating consequences if not promptly diagnosed and treated. 

Let us delve into the causes, symptoms, diagnosis, and management of this intriguing yet serious condition in this blog. 

What is Bone Tuberculosis?

Bone tuberculosis, or skeletal tuberculosis, is a form of tuberculosis that affects the bones and joints. It occurs when Mycobacterium tuberculosis infects the skeletal system, commonly in the spine, hips, and knees. 

Symptoms include joint pain, swelling, and deformities. Diagnosis involves imaging and culture tests. Treatment requires prolonged anti-tuberculosis medication and sometimes surgery.

What are the Types of Bone Tuberculosis?

Bone tuberculosis, also known as skeletal or osteoarticular tuberculosis, encompasses several types depending on the location within the skeletal system, like:

• Spinal Tuberculosis (Pott’s Disease): Primarily affects the spine, leading to vertebral destruction and potential deformity.
• Peripheral Tuberculosis: Affects bones outside the spine like long bones and joints, causing destruction and abscess formation.
• Tuberculous Osteomyelitis: Infection of bone marrow, presenting with bone pain, swelling, and abscesses.
• Tuberculous Arthritis: Infection of joints, such as the hip or knee, resulting in joint destruction and deformity.
• Tuberculous Tenosynovitis: Infection of tendon sheaths, causing inflammation and swelling.

What are the Symptoms of Bone Tuberculosis?

Recognizing bone tuberculosis (TB) can be challenging, especially since spinal TB often lacks early symptoms and pain. Patients may not exhibit any signs until the disease has significantly progressed. Furthermore, TB can remain dormant in the lungs, spreading without detection. However, once bone TB manifests, several key symptoms emerge, such as:

• Severe back pain
• Swelling
• Stiffness
• Abscesses

As bone TB advances, it presents more serious symptoms, which are:

• Neurological complications
• Paraplegia or paralysis
• Limb-shortening in children
• Bone deformities

Interestingly, typical TB symptoms like fatigue, fever, night sweats, and weight loss might not always manifest in bone TB cases. This disease demands vigilance due to its subtle onset and potentially severe outcomes.

What are the Causes of Bone Tuberculosis?

Bone tuberculosis (osteoarticular tuberculosis) is caused by Mycobacterium tuberculosis, typically spreading from a primary infection, often pulmonary TB. Factors contributing to bone TB include:

• Weakened Immune System: Conditions like HIV/AIDS or diabetes increase susceptibility.
• Direct Inoculation: Trauma or surgery can introduce the bacteria directly into bones or joints.
• Hematogenous Spread: The bacteria can travel through the bloodstream to bones and joints.
• Close Contact: Being near individuals with active TB increases the risk.
• Socioeconomic Factors: Poverty and overcrowding can facilitate transmission.

Bone tuberculosis commonly affects the spine, hips, and knees. It leads to bone destruction and joint stiffness if not promptly treated with anti-tuberculosis medications. Early diagnosis and intervention are critical for effective management.

What are the Complications of Bone Tuberculosis?

Bone tuberculosis (TB), also known as skeletal tuberculosis or osteoarticular tuberculosis, though less common than pulmonary TB, can have significant consequences if not promptly treated. Here are the complications associated with bone TB:

• Bone Destruction: TB can erode bone tissue, leading to weakened bones and deformities.
• Joint Destruction: Adjacent joints can be affected, causing loss of function and severe disability.
• Spinal Involvement (Pott’s Disease): TB affecting the spine can cause vertebral collapse, deformities, and neurological issues.
• Abscess Formation: Infection can result in abscesses, causing further tissue damage.
• Joint Stiffness: Chronic inflammation leads to reduced mobility and quality of life.
• Dissemination of Infection: TB can spread to other bones or organs if not controlled.
• Chronic Pain: Particularly in weight-bearing bones or affected joints.
• Secondary Osteoarthritis: Chronic damage can lead to additional joint pain.
• Generalized Symptoms: Fever, weight loss, and fatigue may accompany bone TB.

Early diagnosis and proper treatment with anti-tuberculosis medications are essential to prevent complications. Surgical interventions may be necessary for severe cases to prevent deformities and restore function. Regular follow-up is crucial for complete resolution and managing long-term effects.

How is Bone Tuberculosis Diagnosed?

Bone tuberculosis, also termed skeletal tuberculosis, requires a comprehensive diagnostic approach involving clinical evaluation, imaging studies, laboratory tests, and sometimes biopsy. The diagnostic process includes:

Clinical Evaluation

Initial assessment involves a detailed medical history and physical examination to identify symptoms like persistent joint pain, swelling, stiffness, and soft tissue masses.

Imaging Studies

Various imaging modalities play a crucial role, such as:

• X-rays: Reveals bone destruction, joint space changes, and soft tissue swelling.
• CT Scan: Offers detailed images of bone destruction and joint involvement.
• MRI: Particularly useful for early detection, and assessing bone and soft tissue changes.

Laboratory tests

Several tests aid in diagnosis, like:

• Tuberculin Skin Test: Identifies exposure but not active disease.
• Blood Tests: IGRAs (detect latent infections) and CBC, ESR, CRP (indicators of inflammation in active infections)

Microbiological Tests

Definitive tests include culture for Mycobacterium tuberculosis and PCR for quicker confirmation.

A biopsy is considered if clinical and imaging findings suggest bone tuberculosis. Despite challenges due to nonspecific symptoms, a combination of these methods leads to an accurate diagnosis and appropriate treatment initiation.

What is the Treatment for Bone Tuberculosis?

Treatment for bone tuberculosis involves a comprehensive approach, which involves

• Anti-Tuberculosis Drugs: The cornerstone of bone tuberculosis treatment is a regimen of medications like isoniazid, rifampicin, pyrazinamide, and ethambutol, taken for at least 6 months.
• Combination Therapy: Multiple drugs are used together to prevent resistance. The treatment duration and drugs are determined based on infection severity and overall health.
• Surgical Intervention: Surgery might be needed for severe cases to address bone destruction or joint involvement, including debridement or stabilization.
• Rest and Rehabilitation: Essential for preventing complications and aiding healing. Maintaining mobility may need physical treatment.
• Regular Follow-up: Monitoring progress, checking for side effects, and adjusting treatment as needed through regular healthcare visits.
• Nutrition and Support: A balanced diet supports recovery, bolstering the immune system and healing process.
• Completion of Treatment: Even if symptoms improve, to avoid relapse or drug resistance.

Always seek personalized advice from healthcare professionals for tailored treatment.

How can you Prevent Bone Tuberculosis?

Preventing bone tuberculosis involves these key strategies:

• Vaccination: Consider the BCG vaccine to prevent severe TB forms.
• Hygiene Practices: Regular hand washing reduces exposure risk.
• Avoiding TB Exposure: Minimize close contact with infected individuals.
• Early Detection: Promptly seek medical attention if exposed or symptomatic.
• TB Screening: Recommended for higher-risk groups.
• Treating Latent TB: Prevents progression to active TB.
• Medical Adherence: Follow healthcare advice rigorously for prevention.

By combining vaccination, hygiene, and early detection with lifestyle management, the risk of bone tuberculosis and other severe TB manifestations can be significantly reduced.

Conclusion

Bone tuberculosis, though rare, remains a significant health concern with its impact on skeletal health. Early diagnosis and treatment are pivotal for successful outcomes and preventing severe complications. Understanding its signs and seeking prompt medical attention are crucial steps in managing this challenging condition. It is always advisable to seek medical help from an orthopaedic surgeon. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult an orthopaedic surgeon, reach out to us, or book a direct appointment with pulmonologist  at the CK Birla Hospital. 

FAQs about Bone Tuberculosis

Is Bone Tuberculosis Contagious?

Bone tuberculosis itself is not contagious, but the underlying Mycobacterium tuberculosis bacteria can spread through respiratory droplets if the patient also has active pulmonary TB.

How is Bone Tuberculosis Different from Pulmonary Tuberculosis?

Bone tuberculosis affects the bones and joints, causing localized pain and swelling, while pulmonary tuberculosis primarily affects the lungs, causing cough, chest pain, and respiratory symptoms.

What are the Risk Factors for Developing Bone Tuberculosis?

Risk factors for developing bone tuberculosis include weakened immune systems (e.g., HIV/AIDS), malnutrition, living in or travelling to TB-endemic areas, and having close contact with active TB patients.

Can Bone Tuberculosis Affect Children?

Yes, children can be affected by bone tuberculosis, especially those with weakened immune systems or malnutrition. It can lead to bone pain, deformities, and growth disturbances if left untreated.