Cases of tuberculous joint damage in children in the practice of a rheumatologist

Tuberculosis is an infectious disease that occurs due to Koch bacilli entering the human body. The disease is dangerous because it affects the respiratory system. Less commonly susceptible to tuberculosis are the bones, skin, lymphatic, genitourinary, nervous, lymphatic systems, as well as other organs and systems.

The immune system (the body's natural defense against infection and disease) of most healthy people kills the bacteria without causing symptoms. Sometimes the immune system cannot kill bacteria, but can stop it from spreading in the body. In this case, no symptoms develop, but the bacteria remain in the body. This is called latent (hidden) tuberculosis.

general information

Tuberculosis of the bones of the spine is an infectious process that occurs in one or several places at once. It develops when Koch's bacillus gets into the tissue. Several months pass from the onset of development to the appearance of the first symptoms. This is one of the most common forms of osteoarticular tuberculosis. It occurs mainly in men, but it is often diagnosed in women.

The disease affects the thoracic region in 60% of cases, the lumbar region in 30%, and the cervical and sacral region in 5%. The process can spread either to one vertebra or to several at once. Most often, two or more segments are involved. The bone form is often combined with other forms of tuberculosis in the body.

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Classification of tuberculosis

The disease is classified according to location, degree of development and number of lesions. According to the prevalence of the lesion, the pathology is divided into the following forms:

• Local (tuberculous osteitis) is a single focus, the process does not extend beyond the bone segment, and is considered the mildest form.
• Multiple – affects several segments of the ridge at once, and can be diagnosed in non-adjacent vertebrae. The form progresses quickly and leads to serious consequences.
• Combined – the focus of infection is observed not only in the spine, but also in the internal organs, most often in the lungs. The most severe form, requiring a long treatment process.

The pathology develops in several stages. At the first stage, the patient has a single lesion and moderate symptoms. As it progresses, it extends beyond the bone segment and processes from bone tissue are formed. The function of the musculoskeletal system is not impaired. The third stage is considered destructive spondylitis, which intensifies changes in the vertebrae, which leads to loss of the ability to move normally. At the last stage, the inflammatory processes subside, the symptoms are moderate, but at the same time irreversible deformation of the bone structure continues.

Causes

Spinal tuberculosis as a chronic infectious-inflammatory process develops in the body after the penetration of mycobacteria. The pathogen is able to “sleep” for a long time and retain its properties in the external environment, and become active only when it finds itself in conditions favorable for this.

Contributing factors for the development of the disease include:

• Contact with a person suffering from any form of tuberculosis.
• Received back injuries, open fractures.
• Poor nutrition, frequent hunger strikes or chronic malnutrition.
• Excessive exposure to physical or emotional stress.
• Frequent hypothermia of the back.
• Smoking, drug addiction or drinking alcohol.
• Weakened immunity.
• Poor living conditions.

A person becomes infected through direct contact, through the digestive system, by airborne droplets or in utero. At risk are people suffering from diabetes or chronic diseases of internal organs.

There is a high probability of developing tuberculosis in adults due to weakened immunity. It is he who prevents pathogenic bacteria from growing in tissues after entering the body. A decrease in defenses is the main factor contributing to the pathological process.

An X-ray allows for early detection of the presence of bone tuberculosis.

How dangerous is the disease?

Damage to the spine is always provoked by mycobacteria, which, upon entering the body, spread through the circulatory and lymphatic systems. The lesion is in the center of the vertebra, in rare cases in the processes or arches. As they develop, granulomas form, which destroy the bone structure and cause an abscess. Not only the vertebra, but the intervertebral disc suffers, as its height gradually decreases, its shock-absorbing properties decrease, and the mobility of the spine is impaired.

If the immune system is strong, then the granulosa tissue degenerates and a scar forms in its place, thus the disease stops and the bone structure is gradually restored. Against the background of weakened protective forces, tuberculosis rapidly progresses, the abscess spreads to soft tissues, and necrosis develops.

How dangerous is the pathology?

Spinal discitis and its treatment

• Orthopedic disorders, vertebral instability and curvature of the spinal column.
• Imbalance of protein metabolism.
• The appearance of fistulas, radicular syndrome.
• Secondary immunodeficiency.
• Disturbances in the functioning of internal organs.
• Paresis of varying severity.

The disease has no restrictions on age or gender, and is equally often diagnosed in children and adolescents. It occurs in an acute form, affecting deep structures. Elderly people suffer from superficial lesions, but more extensive ones with moderate manifestations.

Symptoms

Symptoms of spinal tuberculosis in the early stages are manifested by discomfort in the back, which patients often attribute to overwork. The pain intensifies even with minor exertion, and increased fatigue is observed. Body temperature rises to 37.5-38C. After a good rest, the symptoms subside. As it develops, the clinical picture becomes more pronounced, the patient develops muscle weakness, stiffness of movement, and severe aching pain. Signs of tuberculosis directly depend on the location:

• Cervical region. The patient complains of frequent headaches, accompanied by nausea and dizziness. The person is unable to concentrate normally, there is deterioration in vision and hearing, and confusion.
• Thoracic department. The patient complains of severe pain localized between the shoulder blades. They get worse when you try to take a deep breath. Over time, there is weakness in the hands, numbness in the fingertips, and tingling in the heart area.
• Lumbar region. Dull pain appears in the lower back, causing agony to the patient. There is weakness in the legs, making it impossible to walk even a short distance. There is also a feeling of numbness, muscle spasms, and tingling in the limbs from time to time. Severe lesions are provoked by dysfunction of the intestines and bladder.

In advanced stages, the patient develops a pronounced deformity of the spine, which is manifested by a hump on the back. Fistulas appear in the affected area, and the ability to move normally is completely lost. You should pay attention to even minor changes in the condition in the early stages, this will allow you to start treatment on time and prevent serious consequences.

Diagnostic procedures

Diagnosing tuberculosis is a complex process, because to identify a pathological process, the presence of several pronounced symptoms is not enough. The doctor prescribes a series of instrumental and hardware studies to confirm the presence of changes in the bone structure, abscesses or narrowing of the spinal canal. Typically the following methods are used:

• Radiography.
• Ultrasonography.
• Computer or magnetic resonance imaging.
• Biopsy.
• Polymerase chain reaction.

X-ray is the main diagnostic method to detect any changes in bone tissue. In addition, laboratory tests are prescribed, such as Diaskintest or Mantoux test. The results obtained make it possible to detect even minor changes with high accuracy and prescribe the correct therapy to the patient.

In adolescents and children, the diagnosis is often controversial and additional studies are required to exclude Calve or Scheuermann-Mau disease. Sometimes tuberculosis can be confused with congenital malformations, tumor metastases in another location, or a malignant tumor. All this requires additional differential diagnosis.

It is clear how tuberculosis develops in bone structures

Diagnostics

To make an accurate diagnosis, symptoms alone are not enough, so the patient is prescribed instrumental diagnostics. The traditional method is radiography in the lateral and anteroposterior projection. This makes it possible to determine the localization of the infectious focus, the degree of change in the tissue structure, the presence of abscesses and narrowing of the spinal canal. For a more accurate analysis, MRI or CT is recommended, especially in severe cases. Additionally, a blood test and tuberculin test are done.

X-rays are most often used to diagnose spinal tuberculosis.

Treatment

Treatment of spinal tuberculosis is carried out in a hospital setting, where the patient is placed immediately after diagnosis. The treatment regimen is drawn up individually, taking into account the patient’s age, stage of the process and the presence of chronic pathologies. The main objectives of the chosen tactics are:

• Stimulates defenses and strengthens the body.
• Lifestyle adjustments for stable long-term remission.
• Suppression of the growth of pathological bacteria.
• Prevention of complications.
• Elimination of manifestations of the pathological process.
• Restoring the function of the musculoskeletal system.

Treatment involves long-term rehabilitation, with an integrated approach. It includes chemotherapy aimed at preventing the development of serious deformities and complications, taking medications, and surgery to preserve the function of the musculoskeletal system. A TB doctor and a vertebrologist prescribes a plan for combating the pathology. On average, treatment lasts about 3 years.

Drug treatment

Drug therapy is aimed at combating the causative agent of the disease. The doctor prescribes courses of antibacterial agents, hormonal drugs, and vitamins that can not only eliminate the symptoms, but also achieve stable remission of the pathology. The complex usually includes the following drugs:

• “Isoniazid” - N. The drug acts directly on pathological mycobacteria, therefore it is used for any localization of tuberculosis. It destroys the cell wall of Koch's bacillus and prevents it from rapidly growing in the body, provoking irreversible changes in bone tissue.
• "Rifampicin" - R. A semi-synthetic drug with an anti-tuberculosis spectrum of action. High activity is achieved due to the suppression of mycobacterial DNA.
• “Pyrazinamide” - Z. The drug penetrates the lesion and affects the affected cells and the tuberculosis pathogen itself. Has a general bactericidal effect.
• "Ethambutol" - E. The drug is aimed at suppressing the growth of bacteria, disrupting their growth and creating unfavorable conditions for reproduction. All this leads to the death of Koch's bacillus and prevents the synthesis of its RNA.

It is simply impossible to cure diseases without the use of antibacterial agents. The regimen is compiled individually and is aimed at suppressing the development of bacterial infection. In addition to medications, an individual diet is prescribed to restore normal immune function. It is useful to spend more time in the fresh air, preferably near juniper groves.

Physiotherapy

In addition to aggressive medications, the doctor prescribes proven physiotherapeutic methods to combat pathology. They are not used independently, but in combination with others, they allow you to get good results. Measured methods are:

• Electrophoresis. The treatment is carried out by applying a small electric current. With its help, medications penetrate deep into the tissues and act directly on the affected area.
• Magnetotherapy. The technique is based on the work of constant and alternating magnetic fields that affect the source of the disease and promote recovery.
• Laser therapy. Laser treatment is used to treat many diseases, but in the case of tuberculosis, it is prescribed only when indicated.
• Phonophoresis. The technique is based on ultrasonic vibrations and the use of medications.

Physiotherapy is aimed at suppressing the growth of mycobacteria, eliminating the inflammatory process, and thereby slowing down the progression of the disease. The methodology, duration of sessions, intensity of exposure and other parameters are always selected individually, depending on the tasks set and the general condition of the body.

Surgery is one of the ways to treat pathology

Surgical intervention

The advanced stage of development of the pathology is treated with surgery. The operation is aimed at removing destroyed vertebrae and installing implants in their place that can replace them and thereby restore motor function. One of the following transplantation methods is used:

• Albe method.
• Schinle-Whitman method.
• Vreden-Halsted method.

They differ in the way the prosthesis is placed between the processes of the ridge, and the place where the bone plate is taken. This could be a rib, hip bone, tibia. The technique is selected individually by the surgeon.

Plaster corset

To alleviate the patient's condition, specific treatment methods are also used. One of which is the use of a plaster corset. This is an artificial method of fixing the vertebrae, preventing complications in advanced cases.

Before applying the corset, the patient is suspended on a special Sayrov apparatus. It allows you to completely straighten the spine and take each bone segment into its normal position. After this, bandages, cotton wool and a plaster cast are applied. A hole is made in the abdomen to ensure free breathing. If the corset is removable, the body is lubricated with Vasiline before fixation.

Drugs for spondylitis

Drug therapy is the main treatment for spondylitis. In addition to antibiotics to eliminate the underlying disease, nonsteroidal anti-inflammatory drugs (NSAIDs) are considered the leading drugs. They allow you to relieve the symptoms of inflammation, remove swelling and completely or partially eliminate pain. NSAIDs cannot be taken constantly - they are prescribed only during exacerbations, since they negatively affect the gastrointestinal mucosa.

For severe inflammation and extensive necrosis of spinal tissue, glucocorticoid steroids are prescribed. This group of drugs is also intended for short-term symptomatic use, since long-term use can only worsen spondylitis.

In case of infectious intoxication of the body, drip intravenous administration of solutions to remove toxins is indicated. To protect healthy tissues and improve metabolic processes, B vitamins, blood microcirculation correctors, and vasoprotectors are used.

Due to the fact that the affected spine cannot perform its supporting function in full, the back muscles take on part of the load. Constant overexertion causes severe spasms; to relieve them, patients are prescribed antispasmodics and muscle relaxants.

The only group of medications that really helps restore damaged tissues are chondroprotectors.
Chondroprotective agents for the treatment of spondylitis help accelerate regeneration processes in the spine, protect healthy cells from the adverse effects of toxins and enzymes, and also significantly slow down the progression of the disease. They are most effective in cases of slow or worsening disease, as well as in the recovery period after treatment of septic spondylitis. For spondylitis of various etiologies, doctors recommend a course of Artracam. It is enough to take this chondroprotector in a sachet for 2-4 months a year to prevent or slow down the transition of spondylitis to new joints. Artracam reduces pain, helps prolong remission, and most importantly, allows you to less frequently resort to taking anti-inflammatory drugs that are unsafe for health. Being a natural product based on glucosamine, Artracam has no contraindications for use at any age. And may spondylitis spare your joints!

Preventive actions

Preventing the development of a disease is much easier than treating it. Therefore, it is recommended to minimize the likelihood of infection with Koch’s bacillus. To do this, it is necessary to regularly carry out preventive measures, one of which is vaccination. BCG vaccination is done in childhood, after which diagnostic measures are carried out aimed at monitoring the formation of immunity to mycobacteria (Mantoux test).

Prevention of tuberculosis includes strengthening the immune system through a healthy lifestyle, good nutrition, and exercise. All this helps prevent the development of the disease or its severe consequences. Relatives of tuberculosis patients are required to undergo chemotherapy courses as measures aimed at preventing the onset of pathology.

Spinal tuberculosis is a dangerous disease that develops in bone structures. Its insidiousness lies in the absence of characteristic symptoms, which does not allow starting treatment in the early stages. It is widely found in both adults and children, and without complex therapy, the pathology can lead to serious consequences, including disability.

Prevention of pathology

The main preventive measure against tuberculosis is vaccination. Timely vaccinations reduce the risk of disease to a minimum, even under unfavorable living conditions. It is also very important to undergo fluorography annually - in case of infection, this will identify the disease at an early stage and shorten the treatment period. You need to spend more time in the fresh air, pay enough attention to physical activity, follow a diet and sleep schedule.