High incidence of new onset joint pain in patients receiving fluoroquinolones as part of anti-tuberculous treatment

Background: Hyperuricaemia secondary to pyrazinamide (PZA) leading to joint pain is reported. There is paucity of data regarding new onset joint pain in patients receiving anti tuberculous treatment (ATT) in whom PZA is not administered. Fluoroquinolones (FQ) have been reported to be associated with tendonitis and joint pain and are also used in ATT regimens. Aims: Study the association of FQ and joint pain in patients receiving ATT. Methods: 210 consecutive patients treated for tuberculosis were included. 28 patients were excluded (23 followed up with primary physician, 5 pre-existing arthritis). Results: 182 patients (mean age 38 years, range 13-90); M:F-48:43. Mean duration of follow up 358+468 days. 106 patients (59%) had drug sensitive TB, 50 patients (27%) drug resistant TB & 26 patients (14%) were treated empirically. FQ used were levofloxacin 34 patients (58%) and moxifloxacin 25 patients (42%). Mean duration of new onset joint pains was 99+117 days (Group 1-56 days, Group 2-127 days, Group 3-135 days).6 patients in Group 1 had hyperuricaemia (37.5%, mean uric acid levels: 9.08 mg/dl). Intolerable joint pains, resulting in stopping of drug/s was 8 of 16 patients (50%) in group 1, 6 of 16 patients (37%) in group 2 and 2 of 7 patients (28%) in group 3. Major joints affected were knees and ankle in all 3 groups. Conclusion: Administration of FQ and FQ plus PZA are associated with high incidence of new onset joint pains in patients receiving ATT. Joint pains associated with FQ have delayed onset as compared to PZA.