• Insidious onset of chronic progressive arthritis, usually monoarticular in knee and hip; usually after osteomyelitis
• More common in children
• First, synovial membrane secretes excessive fluid; then proliferation, thickening, studding of its inner surface with tubercles; finally fibrosis of outer surface
• Leads to fibrous ankylosis of joint with obliteration of joint space
• Can detect from culture, examination of synovial fluid, PCR (apparent false positives in clinically negative patients may represent early disease, Arch Pathol Lab Med 2004;128:205)

• Marginal erosion of hip and knee joints, with destruction of subchondral bone on both sides of joint and loss of joint space

• 2 year old girl with limping of right lower extremity (Reumatol Clin 2011;7:417)
• 34 year old woman from Burma with wrist swelling, initially AFB negative with negative cultures, but subsequent diagnosis of TB tenosynovitis (Hum Pathol 2004;35:1044)
• 40 year old woman with pain and swelling in shoulder (Int J Surg Case Rep 2012;3:164)
• 57 year old woman with swelling and pain in elbow (Korean J Intern Med 2009;24:397)

Arthroscopic view of elbow joint

• Granulomas with caseous necrosis; AIDS patients often have histiocytes with numerous acid-fast organisms but no granulomas

1B: typical caseating tuberculous granuloma

Synovial tissue

Synovial biopsy showing granuloma

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