Tuberculosis Arthritis and Rheumatoid Arthritis

Tuberculosis Arthritis & Rheumatoid Arthritis: Differences MRI overview

Arthritis Tuberculosis (AT) is generally a monoarticular disease that usually involves the spine and medium or large joints, such as hips and knees. Rheumatoid Arthritis (RA) is usually a symmetrical polyarticular disease with peripheral joint involvement common. However, AR may also manifest as monoarticular disease and survive for such a long time. RA and TB arthritis may have similar clinical characteristics, consisting of a chronic form of the periarticular soft tissue swelling, and similar radiological findings, such as periarticular osteoporosis, bone erosion, and the presence of joint effusion, differential diagnosis difficult. Actually, there are reports of cases of arthritis where TB is misdiagnosed as AR or juvenile AR. Value of MRI (Magnetic Resonance Imaging) has been supported in each of the two diseases because of superior soft tissue contrast and the ability to describe changes in cartilage, ligaments, and synovial tissue, especially in the evaluation of early changes. With MRI, the two diseases have been reported heterogenositas low signal intensity in the joint due to body mass, fragments of cartilage, and bleeding.

Monoarticular disease is most commonly caused by a contagious disease process but can also come from non-communicable diseases, such as metabolic or immunologic. In some cases, it is difficult to distinguish the origin of monoarticular disease. Differential diagnosis includes infectious arthritides, such as phylogenic arthritis or tuberculosis, or non-communicable diseases, such as synovial osteochondromatosis, pigmented villonodular synovitis, rheumatoid arthritis, gout, and hemophilic arthropathy, and many others. Appropriate treatment after an accurate diagnosis is essential for a good prognosis and improved joint function, final pathologic diagnosis usually requires a culture of synovial fluid or synovial biopsy or both.

Tuberculosis Arthritis & Rheumatoid Arthritis

RA is a chronic inflammatory arthritis, which affects approximately 1% of the population worldwide, leading to cartilage and bone breakdown and eventual loss of function. Arthritis, tuberculosis is the second in frequency of involvement with spinal tuberculosis, osteoarticular TB is estimated to occur in 1.5-3% of patients with musculoskeletal tuberculosis. The incidence of tuberculosis has increased over the last decade due to increased travel and immigration, an increasing number of elderly, chronically ill patients, or immunosuppression, and an increasing number of patients with AIDS.

RA and TB arthritis, may not only similar clinical manifestations, but also similar radiographic findings, such as periarticular osteopenia, marginal erosion with relatively late from the joint space, and increased joint effusion, which can make differential diagnosis difficult in some cases.

AR and TB arthritis synovial hypertrophy have chronic inflammation. However , on microscopic examination , AR synovium showed infiltration by plasma cells and lymphocytes with or without lymphoid follicles and fibrin deposits are often seen close to the synovial lining or in the stroma , whereas in rheumatoid synovium TB containing material such as fibrin and necrotic , caseous areas , and the number of leukocytes and mononuclear phagocytes . AR consists of articular disease manifestations immunoregulatory dysfunctions are linked by a complex process. In addition to lymphocytes and plasma cells, many different cells, as well as their variable products (cytokines), which contribute to the disease process Lymphocytes , plasma cells , and a large number of cells in the synovium produces many AR , hipervaskular , proliferative lesions , almost resembling a tumor , in response to a proliferative factor produced by activated immune response . In fact, synovial tissue taken from knee arthritis can weigh up to 500 grams or more, in contrast to normal synovium in the knee, which in total is usually, weigh less than 5 grams.

Nonuniform and a greater degree of synovial thickening is more frequent in the AR (p <0.01), the thicker the synovial membrane, the more likely the AR (p <0, 01). TB arthritis bone erosion greater (p <0.01), and the possibility of TB arthritis increases proportionally with the increase in the size of bone erosions (p <0, 01). Rim enhancement in bone erosion in arthritis TB more frequently (p <0, 01). Extra articular cystic masses more and more often seen in arthritis TB (p <0, 01).

Uniform synovial thickening, bone erosion size, rim enhancement in the area of bone erosion, and extra articular cystic masses more often and more on TB arthritis. MRI may help in the differentiation between RA and tuberculosis arthritis.

Reference: AJR 2009; 193:1347-1353

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