Indonesia has the third-highest prevalence of tuberculosis (TB) after India and China. In Indonesia, pulmonary TB is the second-highest cause of mortality among infectious diseases. Three-quarters of the TB prevalence in Indonesia is among those aged between 14 to 49 years old. Osteoarticular TB is an uncommon form of extrapulmonary TB (EPTB); it comprises 1-6% of all TB cases and 10-15% of all EPTB cases. The most frequent sites of osteoarticular TB infection are the spine, hip, and knee.
Osteoarticular TB diagnosis is often delayed. Diagnostic delayed means that there is time interval between onset of symptoms and confirmation of TB to the patients. The cut-off point was 1 months (4 weeks). EPTB results from the hematogenous and lymphatic spread of M. tb bacilli. Tuberculous osteomyelitis and arthritis generally arise due to the reactivation of bacilli lodged in the bone during the original primary infection. The predilection of the bacillus for large joints is due to the rich vascular supply in the growth plates of the long bones. Tuberculous arthritis is believed to result from the extension of the initial infection of the bone to the joint. In the Netherlands and England, concomitant pulmonary TB has been reported in 29% and 15% of osteoarticular TB patients, respectively. In Karachi, Ali et al reported concurrent pulmonary TB in nearly 50% of osteoarticular TB cases. However, only 6.9% of 5337 osteoarticular TB cases had concurrent pulmonary TB. Similarly, a study performed in Turkey and Denmark also found low rates of concomitant pulmonary TB in osteoarticular TB cases. Despite its prevalence in other countries, osteoarticular TB is still underdiagnosed in Indonesia.
In this study, 30 osteoarticular TB cases from two government hospitals in Jakarta, Indonesia, were retrospectively analyzed. This study aims to provide clinical and radiologic-histopathologic descriptions of delayed osteoarticular TB, its management, and outcomes.