Tuberculosis of wrist joint in a patient with Rheumatoid Arthritis on conventional DMARDS- useful function despite gross bony destruction at 3 years follow up

In some developing countries, patients undergoing treatment of Rheumatoid Arthritis (RA) with biological agent have a substantial increase in the incidence of tuberculosis (TB). But incidence of specific association of skeletal tuberculosis in RA patient on conventional DMARDS is not specifically mentioned in the literature. We present a case of a lady who developed tuberculosis of wrist near about 2 years after she was on conventional DMARDS for RA. Her tuberculosis of wrist joint was initially missed. She was managed conservatively and concurrently with DMARDS and anti-tubercular drugs for both the diseases. At 3 years follow up, both diseases are under control with painless functional range of motion of the wrist despite presence of radiological gross bony destruction.