Comprehensive review of osteoarticular tuberculosis: from epidemiology to emerging therapies

Osteoarticular tuberculosis (OATB) remains a significant global health challenge with high morbidity and potential for permanent disability. Recent advancements in diagnostics, pharmacotherapy, and adjunctive treatments have shown promise for improving the outcomes of patients with OATB. This review summarizes the latest developments in the field, focusing on epidemiology, pathogenesis, diagnostic innovations, novel anti-tuberculosis drugs, combination therapy approaches, surgical interventions, adjunctive therapies, and the importance of multidisciplinary approaches. Emerging diagnostic technologies such as advanced imaging modalities, molecular assays, and nanotechnology-based tests have enhanced the speed and accuracy of OATB detection. Newer anti-tuberculosis drugs, including bedaquiline, delamanid, and pretomanid, have demonstrated efficacy in multidrug-resistant (MDR) and extensively drug-resistant (XDR) cases, whereas DprE1 inhibitors and oxazolidinone alternatives show promise in early phase trials. Minimally invasive surgical techniques, joint-preserving procedures, and reconstructive methods using 3D-printed implants and antibiotic-loaded materials have improved functional outcomes. Immunomodulators, bone grafts, and regenerative medicine have been explored as adjunctive therapies. Effective management of OATB requires collaboration among various specialists, and integrated care models facilitate personalized treatment plans. Challenges remain, including drug resistance, and the need for further research to establish optimal regimens and durations specific to OATB. By highlighting key advancements and their potential impact on patient outcomes, this review underscores the importance of a multidisciplinary evolving paradigm for treating OATB in the era of precision medicine.