Young most at risk, says study on skeletal tuberculosis after 50 years

THE FIRST such study in more than 50 years in the country to assess the burden and distribution of skeletal tuberculosis has found that spine is the most commonly affected site in 65 per cent of the patients.

The six-year study, covering 102 male and 117 female patients, also showed that skeletal TB was most common in the age group of 20 to 30 years, with 66 per cent of the cases between the ages of 11 and 30. Eightyseven per cent of the test cases in the study, published in Indian Journal of Tuberculosis, were under 40 years of age.

Conducted between January 2007 and January 2012 at Ramakrishna Mission Free TB Clinic in Delhi, the study found that in most patients in this young age, spine was involved in some form or another, with more than half (53.9 per cent) showing isolated spinal effect.

While skeletal TB, which involves bones and joints, itself constitutes only 2 per cent of TB cases in the country, it can lead to substantial morbidity and poses serious occupational and socio-economic problems. Patients with spinal TB are among the worst hit, facing long therapy with the risk of neurological complications.

The Ramakrishna clinic is one of the biggest district TB centres in Delhi, and saw over 11,000 patients during the review period. The clinic has been functional since the inception of the Revised National Tuberculosis Control Programme (RNTCP) in 1998.

Dr Rajat Chopra, the author of the study, who is a consultant with Department of Orthopaedics at Delhi’s Sir Gangaram Hospital, said, “The rate of spinal TB in this study is much higher than reported in any other study... We didn’t know which part of the body was getting involved in skeletal tuberculosis. The last study was in 1965, conducted at Banaras Hindu University. This study reveals that it is the younger population which is getting affected and spine is the most common site of skeletal TB. This is a productive age group and backbone of the country, which is the most affected... In males, the incidence peaks in the second decade (of life) and in case of females, the incidence peaks in the third decade.”

Pointing out the financial implications of the findings, Dr Chopra added, “The study group involved a big migrant population, who were in Delhi for employment. In cases where a patient has to go in for surgery, he or she is immobilised for three months. This can lead to a financial burden on the family.”

Dr Chopra also pointed out that skeletal TB in India was not showing a decline.

In developed countries, most of the patients with spinal TB are immigrants from countries such as India where TB is endemic. A six-year-long study in the UK showed that 74 per cent of skeletal TB patients were immigrants from the Indian subcontinent.

Dr Chopra called for closer coordination between surgeons, DOTS providers and physicians. DOTS, or ‘Directly Observed Treatment, Short-course’, is the internally recommended strategy for TB control.