Bone and joint tuberculosis is a relatively common type of extrapulmonary tuberculosis, the course of which is prolonged, often causing great distress and pain to the patient, and is one of the more difficult types of tuberculosis. So how does bone tuberculosis actually occur and develop? Below, we will recognize it. First of all, it is a kind of secondary tuberculosis, the primary lesion is usually pulmonary tuberculosis or digestive tract tuberculosis. In China, the majority of cases are primary to pulmonary tuberculosis. Bone and joint tuberculosis can appear in the active stage of tuberculosis, but most of them occur after the primary lesion has been quiescent, or even healed for many years. During the active period of primary lesions, Mycobacterium tuberculosis reaches the bone and joints through blood circulation, and it may not necessarily develop immediately, but it can lie latent for many years in the bone and joints, and active tuberculosis can be induced by the decline of body resistance, such as traumatic injury, malnutrition, over-exertion, diabetes mellitus, major surgery and other triggering factors. The traditional concept is that bone and joint tuberculosis occurs in children and adolescents, with the prolongation of the average life expectancy of the population, the probability of the elderly suffering from bone and joint tuberculosis has also increased significantly, according to statistics, in China, the prevalence of bone and joint tuberculosis in children (0-14 years old) is 9.5%; while the prevalence of the elderly (65 years old and above) is 14.7%. The most common sites of bone and joint tuberculosis are those with heavy loads, many activities and easy trauma. For example, the best site is the spine, accounting for about 50%, and thoracolumbar vertebrae are more common, cervical vertebrae are rare. Next is the knee joint, hip joint and elbow joint. The majority of joint tuberculosis lesions are solitary, while a few are multiple, and symmetry is rare. What are the symptoms of bone and joint tuberculosis? 1, pain: spinal tuberculosis “pain” is the first symptom. Usually it is a mild pain, which is aggravated after activity and reduced after rest. Children often have “night crying”. In addition to neck pain, cervical spine tuberculosis also has upper extremity radiating pain and numbness and other nerve root irritation, compression, coughing, sneezing will make the pain and numbness aggravated. If there is abscess in the posterior wall of the pharynx, it may hinder breathing and swallowing, and there is snoring during sleep. In the later stage, the neck mass caused by cold abscess can be found on the side of the neck. Patients with tuberculosis of the thoracic spine have symptoms of back pain, and pain from lower thoracic spine lesions sometimes manifests as lumbosacral pain. Kyphosis is very common, and some patients do not present to the hospital until they discover the kyphosis by chance. Inflammatory tissue that irritates the nerve roots may cause radiating pain to the ribs, and paraplegia may occur when the diseased tissue enters the spinal canal. When standing or walking, patients with lumbar spine tuberculosis tend to hold their lumbar region with both hands, tilt their head and trunk backward, and shift their center of gravity backward to minimize the pressure of body mass on the diseased vertebrae. Inflammatory tissue stimulation of the nerve root will produce radiating pain in the lower limbs, in severe cases, a large number of lesions into the spinal canal compression of the dural sac, the cauda equina symptoms, leading to dysfunction of urination and defecation. 2.Tuberculosis toxicity symptoms: patients with slow onset, low fever, fatigue, night sweats, emaciation, loss of appetite and anemia, etc.; there are also acute onset of high fever and toxaemia, usually seen in children and patients with poor immunity. 3.Localized swelling or fluid accumulation: spinal tuberculosis abscess can be up to subcutaneous, appearing in the waist triangle, chest wall, groin, thighs, and some patients consult the doctor in this way. Superficial joints can be detected with swelling and effusion, and pressure pain, joints are often in semi-flexion state to relieve pain; to the late stage, muscle atrophy, joints are pike-shaped swelling. 4, sinus tract or fistula formation: osteoarticular tuberculosis development results in the accumulation of a large amount of pus, tuberculous granulation tissue, dead bone and caseous necrotic material in the lesion site. The abscess may flow through the tissue spaces and ulcerate toward the body surface to form a fistula. Abscesses can also communicate with hollow visceral organs to become sinus tracts. A prolonged sinus fistula can combine with other pathogenic infections leading to hyperthermia and an exacerbation of the local acute inflammatory response. The result of heavy mixed infection is chronic consumption, anemia, obvious toxic symptoms, and even death due to liver and kidney failure. Paraplegia: spinal tuberculosis bone destruction and formation of dead bone or abscess will compress the spinal cord and produce paraplegia, which is common in cervical and thoracic vertebrae. 6.Pathological fracture and dislocation: tuberculosis lesions can lead to pathological fracture and dislocation of bones and joints. In addition, tuberculosis will also leave some sequelae: fibrous adhesion of joint cavity to form fibrous ankylosis and produce different degrees of joint dysfunction; flexion contracture of joints and vertebral destruction to form a spinal backward deformity, that is, what we often call hunchback; children’s bone destruction will produce bilateral limb length inequality. After reading the above introduction, you may have a fear of bone and joint tuberculosis, which is unnecessary, we still have many effective ways to deal with it. 1, rest and nutrition is the best supportive therapy, follow the doctor’s instructions, pay attention to rest, especially more bed rest, in order to better cooperate with the local braking, as far as possible to avoid the lesion part of the activities and weight bearing. The spine can be protected with a neck brace or abdominal band. At the same time, strengthen the nutrition, daily intake of sufficient protein and vitamins. In order to ensure the rest of the lesion and reduce pain, immobilization and braking are very important. Local braking includes plaster, brace fixation and traction. The efficacy of local braking is better than anti-tuberculosis drug treatment alone. The immobilization time should be enough, generally the period of immobilization for small joint tuberculosis is 1 month, and the period of immobilization for large joint tuberculosis should be extended to 3 months. Skin traction is mainly used to relieve muscle spasm, reduce pain, prevent pathologic fracture, dislocation, and can correct joint deformity. 3, chemical drug treatment is essential, and the course of treatment is longer than ordinary tuberculosis, usually 1 year to 1.5 years, such a long treatment often need patients to be able to cooperate with patience, stopping or interrupting the use of drugs may lead to the emergence of drug-resistant and abandoned. 4.If there is bone and joint tuberculosis with obvious dead bone and abscess formation, sinus tracts that do not heal for a long time, spinal tuberculosis with spinal cord compression, nerve root irritation symptoms, etc., surgical treatment should be considered. The main methods of surgery include incision and drainage of pus and lesion removal, through which the pus, dead bone, tuberculous granulation tissue and caseous necrotic material at the lesion site are discharged or completely removed, and the lesion removal can be carried out at the same time of systemic anti-tuberculosis drug treatment to achieve good efficacy and short duration of treatment.