CONTEXT: Tuberculosis of the joints and bones is a significant worldwide problem, often leading to joint and bone destruction. The diagnosis of this disease manifestation is difficult. OBJECTIVE: To assess the role of conventional diagnostics compared to polymerase chain reaction applied to samples obtained at arthroscopy. DESIGN: This was an open observational study that was blinded to the microbiologist, histopathologist, and molecular biologist responsible for assessing the main outcome measures. PATIENTS: Seven patients (8 samples) with joint and bone tuberculosis and 14 patients (16 samples) with nontuberculous joint and bone disease. INTERVENTION: Arthroscopic examination and tissue sample collection. MAIN OUTCOME MEASURES: Mycobacterium tuberculosis staining, culture, and histopathologic assessment of caseating granulomas vs polymerase chain reaction. RESULTS: Polymerase chain reaction was positive in all cases of true tuberculosis and falsely identified 2 samples as positive, both however, in patients who had lung tuberculosis in the past. CONCLUSIONS: Conventional bacteriological methods for demonstration of M tuberculosis are not very sensitive and can be time-consuming. Polymerase chain reaction of arthroscopically obtained joint tissue biopsies appears promising in the early diagnosis of tuberculous arthritis.
CONTEXT: Tuberculosis of the joints and bones is a significant worldwide problem, often leading to joint and bone destruction. The diagnosis of this disease manifestation is difficult. OBJECTIVE: To assess the role of conventional diagnostics compared to polymerase chain reaction applied to samples obtained at arthroscopy. DESIGN: This was an open observational study that was blinded to the microbiologist, histopathologist, and molecular biologist responsible for assessing the main outcome measures. PATIENTS: Seven patients (8 samples) with joint and bone tuberculosis and 14 patients (16 samples) with nontuberculous joint and bone disease. INTERVENTION: Arthroscopic examination and tissue sample collection. MAIN OUTCOME MEASURES: Mycobacterium tuberculosis staining, culture, and histopathologic assessment of caseating granulomas vs polymerase chain reaction. RESULTS: Polymerase chain reaction was positive in all cases of true tuberculosis and falsely identified 2 samples as positive, both however, in patients who had lung tuberculosis in the past. CONCLUSIONS: Conventional bacteriological methods for demonstration of M tuberculosis are not very sensitive and can be time-consuming. Polymerase chain reaction of arthroscopically obtained joint tissue biopsies appears promising in the early diagnosis of tuberculous arthritis.
Authors: Anil K Jain; Santosh Kumar Jena; M P Singh; I K Dhammi; V G Ramachadran; Geeta Dev Journal: Indian J Orthop Date: 2008-04 Impact factor: 1.251