A 28-year-old man on treatment for sputum-positive pulmonary tuberculosis develops symmetrical pain and swelling of both wrists, metacarpophalangeal joints, and ankles. Joint aspiration shows a sterile inflammatory fluid with lymphocytic predominance, and radiographs show no erosions. Symptoms resolve completely with continuation of antitubercular drugs. The most likely explanation is:
- A Haematogenous seeding of mycobacteria into the synovium
- B Poncet disease, a reactive polyarthritis associated with active tuberculosis ✓
- C Gout precipitated by pyrazinamide therapy
- D Rheumatoid arthritis unmasked by immunosuppression from tuberculosis
Correct answer: B. Poncet disease, a reactive polyarthritis associated with active tuberculosis
Explanation
Poncet disease is a form of reactive polyarthritis occurring with active tuberculosis in which no mycobacteria can be isolated from the joints, and it heals fully with antitubercular treatment. Sterile aspirate, absent erosions, and resolution on therapy exclude true tuberculous arthritis, which requires demonstration of bacilli in the joint. Pyrazinamide-induced hyperuricaemia would show crystals in the aspirate.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.