Tuberculosis is an infectious disease that seriously endangers people’s health, and bone and joint tuberculosis is one of the most common and most harmful extra-pulmonary secondary tuberculosis. Beijing Chest Hospital statistics: bone and joint tuberculosis accounts for 1% to 3% of pulmonary tuberculosis, the preferred site is the spine, accounting for 70% of bone and joint tuberculosis. Especially, the increase of patients with refractory, relapsing retreatment and drug-resistant bone and joint tuberculosis in recent years has made the treatment of bone and joint tuberculosis more difficult; improper prevention and treatment of drug-resistant tuberculosis will lead to primary drug resistance of bone and joint tuberculosis, which is the main cause of retreatment and recurrence of bone and joint tuberculosis Several articles published in this issue have studied and described different surgical treatment methods and effects of bone and joint tuberculosis patients from different directions, as well as perioperative The articles in this issue have studied and elaborated different surgical treatment methods and effects for patients with osteoarthritis, as well as the adjuvant treatment and good nursing care in the perioperative period. In addition, domestic scholars have also recently made a large number of related reports, which have played a positive role in improving the diagnosis and treatment of osteoarticular tuberculosis and in reaching an expert consensus in this field. However, as a systemic disease, osteoarticular tuberculosis is a bacterial and immune-responsive disease, which has yet to be recognized by physicians in non-tuberculosis hospitals. At present, it is of great importance to further improve the awareness of tuberculosis among related professionals, pay attention to extrapulmonary tuberculosis and standardize the diagnosis and treatment of osteoarticular tuberculosis. The early diagnosis of osteoarticular tuberculosis is still an urgent problem to be solved. Patients with osteoarticular tuberculosis are consulted in the orthopedic department of general hospitals at an early stage, and general orthopedic surgeons have insufficient knowledge and experience in osteoarticular tuberculosis, so they tend to ignore the diagnosis of osteoarticular tuberculosis. In addition, each existing examination method has its own limitations, for example, the enzyme-linked immunospot test for tuberculosis T cells (T-SPOT.TB) cannot distinguish between latent infection of Mycobacterium tuberculosis and active tuberculosis; the PCR fluorescence assay of Mycobacterium tuberculosis and the DNA sequence assay of Mycobacterium tuberculosis are expensive and technically complicated, and are currently carried out only in a few hospitals. Yuan Huishu et al. performed spinal puncture biopsy under CT surveillance and confirmed the diagnosis in 77.4% of patients with tuberculosis, but the method is not suitable for widespread dissemination because of contraindications to puncture and the difficulty and high technical requirements of the operation. Although the liquid culture method of Mycobacterium tuberculosis shortens the time of culture and drug sensitivity test, it can only be done in some large TB hospitals due to the need of biosafety protection; Mycobacterium tuberculosis DNA sequence determination [such as linear probe multidrug resistance detection technology (HAIN), TB and rifampin resistance rapid molecular identification (X-Pert)], although rapid, can only determine isoniazid and rifampicin resistance genes. All of these tests require specialized equipment, laboratories, and skills training of relevant personnel, but this is exactly what is lacking in non-tuberculosis specialty hospitals and primary TB hospitals. Currently, Mycobacterium tuberculosis culture and mycobacterium type testing are still the gold standard for confirming the diagnosis of tuberculosis; the results of drug susceptibility testing, referred to as “drug sensitivity testing”, can guide the rational clinical selection and application of anti-tuberculosis drugs. Because of the low positivity rate of the traditional method of culture and the long time for the results of drug susceptibility testing, there is often a disconnect with clinical treatment, resulting in delays in the early treatment of drug-resistant tuberculosis. Therefore, a considerable number of patients may be diagnosed only when the disease progresses to the typical manifestation of imaging examination, but at this time, the disease is already advanced, and these patients will be poorly treated or cured with varying degrees of disability, which brings heavy economic burden and life and work pressure to the society, families and patients themselves. Second, standardize the application of anti-tuberculosis drugs The primary treatment of osteoarticular tuberculosis is the application of anti-tuberculosis drugs. Anti-tuberculosis drug treatment is the basis for the treatment of osteoarticular tuberculosis, and effective anti-tuberculosis drug treatment is the root of the cure of osteoarticular tuberculosis and runs through the whole treatment process. For patients with primary treatment, a 1-year regimen of 3HRSE/9HRE is used; in addition, a 1.5-year regimen of 6HREZ/12HRE is preferred; for relapsed patients: 1.5-year regimen of 6HREZ/12HRE is used for those with unknown drug resistance, with timely adjustment after obtaining drug sensitivity test results; and for drug-resistant TB, 6ZAmKm, Cm, LfxMfx, PASCs , E, Pto/18ZLfxMfx, PASCs,E,. For MDR-TB:Patients should be included in the MDR control strategy (DOTS-Plus) as much as possible, as in the case of pulmonary TB treatment, and the duration of preoperative medication can be increased or decreased early and appropriately according to the situation in patients with combined paraplegia; and medication is especially important in elderly and pediatric patients. The duration of anti-tuberculosis drug therapy should be extended to 3-6 months for patients with combined TB elsewhere, such as mycoplasma-positive pulmonary TB, renal TB, liver TB, etc. It is also crucial to master the criteria for stopping anti-tuberculosis drug therapy to prevent recurrence of the disease. The discontinuation criteria should be followed; 1) good general condition, normal body temperature and good appetite; 2) disappearance of local symptoms, no pain and sinus tract closure; 3) X-rays showing abscess shrinkage or even disappearance, or calcification; no dead bone or only a small amount of dead bone, and clear outline of lesion edges; 4) more than one month between each examination, and three consecutive erythrocyte sedimentation rate examinations are normal; 5) the patient has been up and active for one year and still maintains the above four indicators. The surgical treatment of osteoarticular tuberculosis is complex and difficult. The surgical methods have changed and developed through the ages, from simple lesion removal, lesion removal and bone grafting, and staged lesion clearing and bone grafting to internal fixation since 2000, and the surgical methods are improving and developing. Since each patient has its different morbidity characteristics, and also each surgeon has different understanding of the surgical method or the limitation of the level of surgical technique and conditions, it has caused the most controversy. However, there is a need to first reach a consensus and standardize the requirements for surgery, the timing of surgery, and the indications and contraindications for surgery, which play an important role in the success of surgery and lead to the eventual development of appropriate industry rules to regulate inappropriate practice during the diagnosis and treatment of osteoarticular tuberculosis. First, the conditions of the operating hospital are critical in determining the outcome of surgery, especially for spinal tuberculosis, which is more demanding and strict, and some aspects need to be discussed. 1, operating room and anesthesia conditions, and the physician’s proficiency in anterior and posterior surgery. 2, the patient’s age, general condition, and whether other diseases are combined are measured to minimize trauma and perioperative risks. 3, cervicothoracic tuberculosis, thoracolumbar tuberculosis, lumbar-sacral tuberculosis and other lesion sites are very difficult to operate, and the technical requirements for the selection of surgical access are high, and the mastery of the technique is key, so caution should be exercised.4 The mode of internal fixation, whether to perform internal fixation and the technical level of the surgeon are related to the degree of stability of the patient’s spine after treatment, which deserves in-depth discussion due to the lack of research and uniform standards. Second, the indications and contraindications for surgery for osteoarticular tuberculosis. This has been the subject of research by orthopedic scholars, and there are different versions and understandings, which the author recommends and elaborates as follows. Indications for surgery: 1) Bone and joint tuberculosis lesions with obvious dead bone and large abscess formation; 2) Sinus tracts that do not heal over time; 3) Simple bone tuberculosis with high pressure of pus accumulation in the medullary cavity; 4) Simple synovial tuberculosis with poor drug treatment and imminent development of total joint tuberculosis; 5) Spinal tuberculosis with spinal cord compression and nerve root irritation; 6) Severe spinal deformity and instability. Contraindications to surgery: 1. Combination of severe tuberculous meningitis or life-threatening hematogenous tuberculosis. 2. Mixed infections and toxic symptoms that cannot tolerate surgery after comprehensive assessment. 3. Patients with other important diseases that are difficult to tolerate surgery. Strict mastery of contraindications to surgery is also necessary to produce unnecessary surgical complications. Only by strictly grasping and understanding the indications and contraindications of osteoarticular tuberculosis surgery can the cure of osteoarticular tuberculosis be achieved with half the effort. The timing of surgery is the most important for the treatment effect. Under the premise of emphasizing the rational and standardized use of anti-tuberculosis drugs, the dynamic change of patients’ symptoms and signs is the first indication for the timing of surgery. When the temperature is controlled below 37.5 ℃ after reasonable treatment with anti-tuberculosis drugs, it is another key indication for the timing of surgery. Patients with active osteoarticular tuberculosis mostly have afternoon fever of 37.5 to 38.5 ℃. Surgery at this time is not effectively controlled by Mycobacterium tuberculosis, which may lead to failure of surgery and recurrence or spread of tuberculosis lesions. For patients with large abscesses and weak spinal tuberculosis who are commonly seen in clinical practice, anti-tuberculosis drug therapy is slow to take effect and is associated with long-term fever. In addition, perioperative management is also a major factor in the success or failure of surgical treatment, especially nutritional support therapy is necessary for patients with osteoarticular tuberculosis. Because patients are mostly from poor areas and because TB is a chronic wasting disease, nutritional support to enhance the body’s immunity is essential. Local fixation of the joints before and after surgery, as well as the wearing of neck, chest and lumbar braces are also essential for adjuvant therapy. The treatment characteristics of patients with difficult osteoarticular tuberculosis The elderly and pediatric osteoarticular tuberculosis have their own special characteristics. Older patients have declining organ functions, often accompanied by more medical diseases; weak immune response ability, often leading to atypical clinical manifestations; poor tolerance to anti-tuberculosis drugs; long-term bed rest easily leads to a variety of comorbidities; osteoporosis leads to a decrease in the solidity of internal fixation and poor tissue repair ability. Pediatric patients have poor expression ability and are not easy to cooperate during physical examination, which can easily delay diagnosis and treatment. In addition, the poor surgical tolerance of elderly and pediatric patients, the many perioperative complications and the difficulty of management all add to the difficulties in the diagnosis and treatment of osteoarticular tuberculosis. Therefore, it is important to standardize the diagnosis and treatment of osteoarticular tuberculosis in elderly and pediatric patients for clinical work. The emergence of recurrent and relapsing osteoarthritic tuberculosis, as well as drug-resistant, multidrug-resistant and extensively drug-resistant tuberculosis, has also brought new challenges to clinical work. In the past 10 years, especially last year, more than 20% of patients with relapsed relapsed osteoarticular tuberculosis were admitted to our hospital, and the trend is increasing year by year. For patients with drug-resistant, multi-drug-resistant or even extensively drug-resistant tuberculosis, anti-tuberculosis chemotherapy and surgical treatment are very difficult problems and may be an urgent issue in the field of domestic tuberculosis control in the longer term. In addition, long-term immunosuppressed patients and HIV-infected patients with combined tuberculosis often have atypical clinical manifestations and high mortality rates, and the treatment plans for these patients are currently being explored both at home and abroad. In view of the different views and inconsistencies in the diagnosis and treatment of osteoarticular tuberculosis in different units in different regions, and the differences in the level of diagnosis and treatment, we hope to rely on the Chinese Journal of Anti-Tuberculosis as an academic exchange platform with leading, guiding and promoting significance, and to strengthen the cooperation among clinical departments and departments under the attention of the relevant leading departments of tuberculosis prevention and treatment, to discuss and form a consensus on the various aspects of the diagnosis and treatment of osteoarticular tuberculosis, and to standardize the clinical pathways of various types of surgery. In order to standardize the diagnosis and treatment process of osteoarticular tuberculosis, the author suggests: 1. 2. To carry out academic exchanges and multicenter collaborative research between specialist hospitals and general hospitals in the treatment of osteoarticular tuberculosis, so as to extract the best from the worst, avoid the worst and preserve the best, avoid the shortcomings and promote the strengths, and complement each other’s advantages. 3. strengthen the cooperation between clinical and laboratory. Due to the lack of a sound cooperation model between the laboratory and the clinic, the transformation of scientific research results into clinical applications often takes a long time or is interrupted. The development of clinical diagnosis and treatment of osteoarthritis has far-reaching significance. Looking back, we have made efforts and sweat for the diagnosis and treatment of osteoarticular tuberculosis; looking forward, we have the responsibility and obligation to do our work better.