Rheumatic Symptoms During Tuberculosis Therapy

Abstract

A rheumatic syndrome was associated with tuberculosis therapy, most often appearing in the fourth week of drug treatment. The prominent features are pain and contractures involving the shoulders and hands; additional symptoms are morning stiffness and generalized arthralgia. Our recent experience with 7 cases is reported. Suggestive circumstantial evidence and certain experimental data single out isoniazid as the most likely offending agent in the drug regimens. It should be emphasized that the incidence of the syndrome is low, that liver disease and malnutrition may be important co-factors, and that the association with isoniazid must remain tentative in the absence of definitive studies. It is important to recognize the situation promptly since reduction of high dose isoniazid should be considered, and intensive physical therapy initiated in order to forestall significant contractures. It remains to be demonstrated whether or not pyridoxine is of prophylactic or therapeutic value.