AB1360 OSTEOARTICULAR TUBERCULOSIS IN A POPULATION OF WESTERN ALGERIA: A FIVE-YEAR RETROSPECTIVE STUDY
Authors: F. Z. Y. Heddi, Z. Lamri, K. Khelif, W. Zahdour, A. Benammar
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Osteoarticular tuberculosis is uncommon, it comprises 2-5% of all TB cases and 11-15% of extrapulmonary TB cases in Algeria. Because of its unspecific clinical presentation, it can present a diagnostic challenge for clinicians. The most frequent site of osteoarticular TB is the spine. Other joints, such as the hip and knee, are less affected. Multifocal bone involvement is exceptional. <h3>Objectives:</h3> To evaluate clinical features, laboratory and radiological aspects, and management of osteoarticular TB. <h3>Methods:</h3> We analyzed retrospectively the case records of all patients with osteoarticular TB, admitted to our department of rheumatology from 2018 to 2022. We collected demographic data, clinical characteristics, imaging assessment, microbiological and histological data, treatment and follow-up. <h3>Results:</h3> 62 cases (27 males and 35 females) were included, and the mean age of patients was 44.1± 17.5 years. The average time to diagnosis was 11.9±8.8 months [3-36 months]. Twenty patients (32.2%) had at least one comorbid disease: diabetes (24.2%), chronic kidney disease (4.8%), hypertension (1.6%), cancer (1.6%) and rheumatoid arthritis (1.6%). Four patients had a history of pulmonary TB and 16 patients had a history of household contact with TB. The most common symptoms were pain, loss of weight and low-grade evening fever. Local pain was accompanied by swelling in 6 cases and 4 patients complained about limping gaits. Discharging sinus were visualized in 7 cases. Neurological signs were noted in 37.2% of spinal TB. The location of the infections was in spine (88.7%), hip (8.1%), knee (3.2%), shoulder (1.6%) and ankle (1.6%). Eight patients had a multifocal skeletal TB. 90% had elevated erythrocyte sedimentation rate and 81.4 % had elevated C-reactive protein levels. Tuberculin skin test was positive in 50.9%. The most common radiological findings were osteolytic lesion, osteopenia, periarticular erosion, reduced joint space and abscesses. Spondylodiscitis was confirmed by CT scan and/or magnetic resonance imaging. Paravertebral, prevertebral, epidural and psoas abscesses were reported in 37 cases and cord compression in 6 cases. The culture was positive in 50.9% and the histopathological results were consistent with TB in 74.1%. The duration of the anti-TB drugs was 12 months in 61 cases, while one recurrent case received the drugs for 24 months. Three patients underwent surgery and six required an abscess drainage. <h3>Conclusion:</h3> Osteoarticular TB is one of the important forms of extra pulmonary TB. Due to its chronic and progressive nature, the diagnosis can be delayed. It is important to suspect osteoarticular TB clinically and investigate accordingly. Spinal TB is the most common presentation. Anti-TB drugs remain the main stay of treatment. However, surgery may be needed in some cases. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>