In adults, vertebral joint involvement is more common and occurs secondary to tuberculous vertebral osteomyelitis. Usually, tuberculous arthritis is monoarticular and is characterized by the insidious onset, over some months, of joint pain and swelling. Limitation of joint motion or a limp, if the leg is involved, may be the principal finding. The swollen joint feels doughy and is usually not tender. Pain is initially caused by increased intra-articular pressure and later by destructive changes.
Many patients have concomitant constitutional symptoms.
Although only a minority of patients have evidence of concurrent active pulmonary or pleural disease, about half have evidence on x-ray of prior pulmonary tuberculosis. Also in about half of the patients, extrapulmonary tuberculosis is present at one or more sites. There is usually a positive tuberculin skin test reaction to an intermediate-strength inoculum of purified protein derivative. X-rays of the joints show only joint effusion and adjacent osteoporosis early in the disease. Later, subchondral bone destruction and joint space narrowing become visible.