Monday, August 29, 2016

Antituberculosis & Joint Pain


Arthalgia Type 1
Arthalgia Type 2
(Gouty Arthritis)
Possible Causative Agent
pyrazinamide>>ethambutol> isoniazid
pyrazinamide>>ethambutol
Clinical Presentation
  • Pain and tenderness of joints: fingers, shoulders, knees, etc. (usually mild)
  • Symptoms : pain, tenderness and swelling of joints (fingers, shoulders, knees, etc)
  • Symptoms are usually severe
  •  Signs: elevated serum uric acid concentrations
Management
  • TB medications do not require discontinuation
  • Symptomatic relief:  NSAIDS
  • TB medications usually do not require discontinuation
  • If acute swelling is present examined for urate crystals to confirm the diagnosis of acute gouty arthritis.
  • Symptomatic relief:  NSAIDS or colchicine (as alternative to NSAIDS)
  • If recurrent episodes occur, may consider using prophylactic colchicine

Proposed Mechanism
  • A metabolite of pyrizinamide, pyrinazoic acid, inhibits the renal tubular secretion of uric acid and ethambutol reduces its renal clearance.
  • The resulting hyperuricaemia can give rise to arthralgias and very rarely an arthritis.
Reference; 
  1. http://rheumatology.oxfordjournals.org/content/45/9/1173.full
  2.  http://www.uphs.upenn.edu/TBPA/treatment/managingsideeffects.pdf

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