Diagnosis. This may be easy, difficult, or impossible, depending on the duration, the joint involved, and the character of the disease in any individual case.
At times it is impossible to differentiate from syphilis, which, however, is quite uncommon, but with which tuberculosis has many symptoms in common. The history of the individual, and a blood examination will generally suffice. If the disease is advanced to the stage of abscess and sinus formation, there can be no doubt as the nature of the trouble.
Very often the disease in the articular ends of the bones advances slowly, giving very little pain and no appreciable swelling or atrophy. There may be only an unwillingness to use the part very much, and the disease may very well be overlooked. In such insidious cases a diagnosis can be reached by aspiration and subsequent examination of the serous fluid for tubercle bacilli. An X-ray will show the rarifaction of the bony structures and the thickened periosteum.
The course of tubercular joint disease is entirely dependent upon its extent at the time it is recognized, and the treatment pursued. It is of paramount importance that attention be given any persisting pain or discomfort in or near a joint, and that rest and every diagnostic aid be employed before pronouncing a case hysteria, neuralgia or “growing pains.” In a few cases the process can be arrested and little or no diminution of function remains. This, however, is the exception; there is usually destruction of the intra-articular cartilages, and of the synovial membrane, and the formation of bands of great density, which impair the motion of the part even to rigidity (fibrous ankylosis). The restriction of motion may be absolute if ossification of the granulation tissue lying between the epiphyses unites their eroded ends (bony ankylosis).
At times, though recovery seems to have been secured, a sinus may persist because of some slight area of remaining caries, or because the tract itself is tubercular. In other instances a recurrence may follow after months or years of quiescence. This may be due to the setting free of encapsulated organisms, or because of a new infection at a point of least resistance.
Treatment is that of tubercular disease in general. The most essential features in the conduct of these cases are rest and the establishment of ideal hygienic conditions. Forced feeding, sunlight and air, play as important a part here as in pulmonary tuberculosis. Absolute rest of the part can be secured only with the aid of plaster of Paris braces, or splints of other materials. Such immobilization should include the joints immediately above and below the one affected. Hyperemia, by the use of a rubber bandage above the joint, or by baking of the joint, is of great value.
In the majority of instances these methods will yield good results in from six months to a year. Operative interference will be necessary in addition to the above, where caseation and secondary infection have occurred. Thorough drainage of the infected joint, either by widening already existing sinuses, or by free incision followed by irrigation, will frequently be necessary.
Joints Generally Involved are the larger ones of the extremities, but this does not preclude the possibility of any joint being the seat of a tubercular inflammation. The vertebral articulations and the digital articulations of the feet and hands are commonly affected. In children, the hip joint is the one most attacked; frequently the knee, ankle and elbow are affected in the order given.
In nearly all cases of arthritis of tubercular origin the original focus of infection is located in the bone, though the synovial membrane, or an adjacent osteomyelitis, may be the first point attacked.
Syphilitic Arthritis. This is rather a rare condition, but must be differentiated from tuberculosis, because of its slow onset and progress, and because of the mildness of the symptoms and the spindlelike shape of the joint. There is usually but one joint involved and eventually a dark fluid will escape should sinus formation occur.