General principles of osteoarticular tuberculosis.

Since approximately 1985, with the pandemic of the human immunodeficiency virus and with the increase in the number of people who are immunocompromised, there is a resurgence of tuberculosis worldwide. The diagnosis in endemic areas generally can be made on clinical and radiologic examinations. However, whenever there is doubt because of an atypical clinical presentation or lack of clinical exposure, tissue diagnosis is mandatory. If osteoarticular tuberculosis is diagnosed and treated at an early stage, approximately 90% to 95% of patients would achieve healing with near normal function. The mainstay of treatment is multidrug antituberculous chemotherapy (for 12 to 18 months) and active - assisted non-weightbearing exercises of the involved joint throughout the period of healing. Operative intervention is required when the patient is not responding after 4 to 5 months of chemotherapy (synovectomy and debridement), the therapeutic outcome is not satisfactory (excisional arthroplasty for the hip or the elbow), or the healed status has resulted in a painful ankylosis (arthrodesis for the ankle, the wrist, or the knee). Joint replacement may be considered if the disease has remained inactive for 10 years or more. Multidrug resistance should be suspected if the activity of disease does not subside after 4 to 6 months of uninterrupted multidrug therapy. Such patients (5% to 10%) present a desperate therapeutic challenge. Second-line and potential antitubercular drugs, and possible immunomodulations may control such a disease.