PT  - JOURNAL ARTICLE
AU  - Shigehisa Yanagi
AU  - Toshihiko Ihi
AU  - Hiroshi Kuroki
AU  - Toshinobu Higa
AU  - Masamitsu Nakazato
TI  - Link between clinical severity of osteoarticular tuberculosis and the combined presence of pulmonary tuberculosis
AID  - 10.1183/13993003.congress-2016.PA2660
DP  - 2016 Sep 01
TA  - European Respiratory Journal
PG  - PA2660
VI  - 48
IP  - suppl 60
4099  - http://erj.ersjournals.com/content/48/suppl_60/PA2660.short
4100  - http://erj.ersjournals.com/content/48/suppl_60/PA2660.full
SO  - Eur Respir J2016 Sep 01; 48
AB  - Background: Osteoarticular tuberculosis (OTB) is a rare clinical condition, but its incidence is increasing as a result of aging population with chronic diseases, especially in Japan. Delay in the diagnosis of OTB may lead to significant functional disability. Since coincidence of active pulmonary tuberculosis (PTB) in patients with OTB is uncommon, the diagnosis of OTB in the early stage is very difficult.Aims: To clarify the link between clinical severity of OTB and the combined presence of PTB.Methods: With a computer-assisted search, we identified OTB cases between January 1999 and September 2015 at our institution.Results: Thirty-two cases with OTB were identified. Eighteen (56%) cases were female, and with a median of diagnosis of 74 years (26 yo to 91 yo). Main location of the disease was dorsal (14 patients) and lumbar vertebra (12 patients). The most common symptom at presentation was back pain alone (62%). Nine cases (28%) demonstrated paraplegia. The most frequent findings of lung lesion were miliary TB (41%), while 7 cases (22%) demonstrated absent of lung lesion. Sputum smear positivity was lower in patients with OTB than that of in all TB patients treated in our institution. Smear-negative patients had longer duration of delay in the diagnosis of OTB compared to the smear-positive counterparts (148.9 day vs 27.2 day). The sputum smear positivity was lower in patients with paraplegia than that of patients without paraplegia (11% vs 65%).Conclusion: Our results indicated that patients of OTB without complication of PTB resulted in delayed diagnosis and subsequent functional disability. A high index of suspicion is a key for the successful management of OTB.