A brief overview Tuberculous rheumatism is highly likely to be mistaken for rheumatism or rheumatoid. However, the major difference between this disease and rheumatic and rheumatoid diseases is that it does not invade the heart and patients do not suffer from rheumatic heart disease. If patients are treated according to rheumatic or rheumatoid diseases, they mostly show that they do not respond to the drugs used to treat rheumatic or rheumatoid diseases, they are prone to relapse when the drugs are stopped, and their condition is repeated or the relapse is aggravated significantly.
Clinical studies have shown that 95.5% of patients who have had tuberculosis infection but have clinical manifestations of rheumatic or rheumatoid diseases are cured by treatment of tuberculous rheumatic or rheumatoid immune syndrome, although they are diagnosed as rheumatic or rheumatoid diseases by other hospitals.
Symptoms and signs
Tuberculosis is caused when Mycobacterium tuberculosis invades the lungs. In fact, Mycobacterium tuberculosis can also enter other tissues of the body and cause tuberculous meningitis, tuberculous pleurisy, tuberculous peritonitis, intestinal tuberculosis, renal tuberculosis, and also bone tuberculosis and tuberculous arthritis. Although tuberculous rheumatism can occur at any age, it is more common in children, the elderly and malnourished people. Lesions can occur in all joints, but are more common in the hip, knee, and spine, which are heavily weight-bearing and mobile.
The progression of the disease is chronic, with most patients starting in a single joint. The affected joints become painful, swollen, and immobile, and the skin on the joint surface becomes tense, thin, and stiff to the touch. Most of the pain in the joints increases with activity and decreases slightly after rest. During sleep, when the muscles are relaxed, the slightest movement of the joint can cause severe pain, and children often wake up crying in pain in their sleep.
In patients with tuberculous rheumatism, the muscles around the diseased joints atrophy, and joint movement is limited and deformed to varying degrees. In spinal tuberculosis, the lumbar spine is the most common, followed by the thoracic spine. Patients often have difficulty holding up their chests and bending over, and pediatric patients often have to squat to pick up things on the floor, have difficulty putting on socks or tying shoelaces, and develop a hunchback.
Six months to a year after the occurrence of bone and joint tuberculosis, abscesses are formed near or far from the lesions, which are called “cold abscesses” because the local skin is usually not hot. After the abscess breaks down, clear and thin pus flows out, with cheese-like necrotic material, and over time the incision is depressed and the surrounding skin is bruised and darkened, forming a fistula that does not heal.
The main reason for this is that it is not easy to get rid of the problem of rheumatoid arthritis, but it has its own characteristics.
1, most of them are single joint onset.
2, mostly seen in children, the elderly and malnourished people.
3, by X-ray examination, early osteoporosis can be found. In the osteoporotic bone, a translucent lesion shadow without bone tissue, widened joint space and thickened synovial membrane, enlarged lymph nodes, later there may be joint surface erosion, marginal bone destruction defects, late stage can be seen near the joint capsule in the form of dotted or lamellar calcification, joint space narrowing and subluxation and other bone destruction phenomenon.
4. 20% of the specimens with antacid staining of synovial fluid can be seen with Mycobacterium tuberculosis, and 80% of the cultures are positive.
5. Negative rheumatoid factor.
Clinical manifestations
Tuberculosis rheumatism is an allergic reaction to tuberculosis, mostly seen in adolescent females. The clinical manifestations resemble rheumatic fever, so some people call it tuberculous rheumatism. Multiple arthralgias or arthritis, with the large joints of the extremities being more frequently involved. Skin lesions are erythema nodosum and erythema annulare, with the former being more common and appearing intermittently on the extremities, especially on the extensor surfaces of the extremities and near the ankle joints. It is often accompanied by prolonged low-grade fever. Treatment with salicylic acid preparations is ineffective. Other allergic reaction manifestations are leukoaraiosis-like, follicular conjunctival keratitis, etc.
1. Fever: Mostly low-grade fever. High fever often indicates severe active tuberculosis foci in the internal organs, such as cornified tuberculosis. Fever is often accompanied by night sweats and more sweating.
2, joint symptoms: often multiple joints are involved, usually the knee, hip and other large joints first. Later, the small joints of hands and feet may be involved one after another. Symptoms are sometimes mild and sometimes severe, wandering and recurrent. The pain and stiffness are usually heavy in the morning, but it is relieved after activity, without joint deformity or ankylosis.
3. Skin damage: There may be nodular erythema and subcutaneous nodules, with the former mostly seen on the lateral side of the lower leg and near the ankle joint. The former is mostly seen on the lateral extension of the lower leg and near the ankle joint. It often appears one after another, or intermittently in batches. The subcutaneous nodules may co-exist with erythema or exist in isolation, and their distribution is similar to that of erythema.
4.Heart damage: a few may have panic, pulse rate and ECG changes (prolonged P-R period, ST-segment drop, T-wave inversion).
5.Tuberculosis foci: there may be visceral, lymphatic, bursal and paratuberculosis, mostly active and a few inactive. The activity or inactivity of the nodular foci is not consistent with the severity of joint symptoms.
Pathophysiology
Tuberculous rheumatism (also known as tuberculous allergic arthritis), a common form of in vitro allergic symptoms caused by tuberculous metaplasia, is often misdiagnosed as acute rheumatism and is often aggravated by inappropriate treatment. In the early stage of tuberculosis, symptoms of systemic allergic reactions may appear, such as hypothermia, joint pain, or even wandering pain in large joints, mild increase in leukocytes and neutrophils in laboratory tests, and increased blood sedimentation, and the absence of respiratory symptoms or specific symptoms of diseased organs in the symptoms, which are often misdiagnosed as acute rheumatism, and the addition of hormone therapy, which further decreases the already low immune function, causing the disease to progress or worsen. The disease progresses or worsens due to hypothermia, joint pain, increased sedimentation, etc., and is misdiagnosed due to the lack of symptoms specific to organ tuberculosis, which are treated with hormones with immunosuppressive function. This leads to the aggravation of the disease or the expansion of the lesion, causing unnecessary mental stress and economic loss to the patient, and should cause a high degree of vigilance among medical workers.
Tuberculosis rheumatism is a kind of systemic allergic reaction, this allergic reaction symptoms, is caused by tuberculosis allergic reaction in vitro allergic symptoms, common are tuberculosis rheumatism (Ponce + disease) mouth, eye, genital triad (Behce + ‘s) eye herpetic conjunctivitis, nodular erythema of the skin, hard erythema, etc.. These extracorporeal manifestations of allergy have become extremely rare in countries where the incidence of tuberculosis is low.
Diagnostic tests
With primary tuberculosis lesions, in addition to fever, general malaise, and malaise, there are manifestations of multiple joints; pain, aggravated by activity; in the chronic stage, systemic symptoms are not obvious, and only manifestation of multiple joint soreness; second, acute stage of joint redness, swelling, and pressure pain, with nodular erythema of the skin, joint effusion and dysfunction in some cases, but no joint ankylosis and deformity.
No joint bone destruction on x-ray examination.
Increased erythrocyte sedimentation rate and positive PPD test. Anti-rheumatic therapy is ineffective while anti-tuberculosis therapy is effective.
In conclusion, the disease is clinically common but rarely diagnosed and should be a cause for concern!
Differential diagnosis
Tuberculous rheumatism is a nonspecific, noninfectious arthritis first proposed by Poncet’s in 1896 as a metabolic reaction caused by tuberculosis bacilli in the body. As a result of the action of tuberculin, non-specific peripheral inflammation of the soft tissues surrounding the diseased joint occurs, leading to soft tissue swelling, periostitis and fluid accumulation in the joint capsule, joint swelling, and widening of the joint space. The bones near the joints have reduced bone density and osteoporosis due to prolonged inflammatory infiltration and disuse atrophy; the brittleness of bone increases after osteoporosis, and pathological fractures are likely to occur with minor trauma; and the swelling of the joint capsule and muscle atrophy near the joints can cause periosteal reactions. Unlike tuberculosis, which occurs mostly in weight-bearing joints, tuberculosis is symmetrically multi-joint in nature, while it is usually solitary and rarely multiple. The reason for this may be related to the fact that the toxins of tuberculosis and the substances that sensitize the organism and produce metabolic reactions are more likely to reach these joints with the bloodstream than Mycobacterium tuberculosis, and are widely distributed. The diagnosis of this disease should focus on the presence of tuberculosis foci in the patient’s body, the presence of multiple joint pains, nodular erythema near the joints, widening of the inter-articular space, destruction of the joint surface bone, and deformity, in addition to its X-ray manifestations. It is also emphasized that the patient has a positive or strongly positive OT test and that clinical anti-rheumatic fever treatment is ineffective while anti-TB treatment is effective.
In addition, it is important to differentiate from diseases such as arthritis caused by rheumatic fever, rheumatoid arthritis and tuberculous arthritis. Rheumatic fever arthritis often has fever and wandering joint pain, and does not always show positive X-rays. In a few cases, the affected joints are swollen, with joint effusion and osteoporosis, but the edges of the joint surfaces are rough and the bones are destroyed, leaving rare joint deformities; rheumatoid arthritis shows multi-joint involvement, and is easily developed in the small joints of the hands and feet. In rheumatoid arthritis, there is a tendency for multiple joints to be involved, and in addition to swelling of the periarticular soft tissue and osteoporosis, there is limited bone destruction at the edges of the joints and narrowing of the joint space.
Symmetrical swelling of multiple joints and soft tissues around the joints, osteoporosis near the joints, early joint gap widening, rare periosteal reaction, pathological fracture and other accompanying X-ray changes are the main X-ray manifestations of tuberculous rheumatism. Plain X-rays are the preferred method of diagnosing this condition by imaging.
Treatment options
Once the disease is diagnosed, systematic anti-tuberculosis treatment is given for a period of 6 months to 1 year. It takes about 2 weeks for fever, 2-3 weeks for erythema nodosum and blood sedimentation to be controlled. Joint symptoms are slow to respond to treatment and take more than 3 weeks to become effective. Relapse of the disease is still effective with anti-tuberculosis treatment, and relapse is mostly related to the short duration of medication. Treatment with salicylic acid preparations and adrenocorticosteroids is not recommended for this disease because they can only temporarily relieve symptoms but not cure them, and hormones may aggravate tuberculosis. In addition, vitamin B supplements can be given as adjuvant therapy.