Diagnosis of osteoarticular tuberculosis

Accurate diagnosis in osteoarticular tuberculosis poses a difficulty due to deep inaccessible lesions, paucibacillary state, and initiation of empirical ATT in most of the cases. Diagnosis of osteoarticular TB evolved from clinicoradiological to serodiagnosis to detection of DNA/RNA of MTB origin. Newer modalities which aid in early diagnosis and treatment go a long way in management of osteoarticular TB by significantly decreasing morbidity. Subjecting all cases to panel of investigations including AFB staining, AFB culture/sensitivity, PCR, and histopathology on obtaining tissue have been proved more efficacious than resorting to single test. In particular serology alone is not diagnostic. High sensitivity and specificity of PCR and histopathology are found to be most useful diagnostic modalities in studies. Thus gold standard remains to be tissue diagnosis.