Management of DR-TB ADR: Arthralgia

Adverse Drug Reactions (ADRs), such as arthralgia, may occur from the Drug-resistant TB (DR-TB) treatment regimen.

Suspected agent(s): Pyrazinamide (Z), Fluoroquinolone (FQ), Bedaquiline (Bdq)

Suggested Management Strategies​

• Initiate with paracetamol in the beginning. ​
• Treatment with non-steroidal anti-inflammatory drugs (Indomethacin 50 mg twice daily or Ibuprofen 400 to 800 mg three times a day). ​
• Lower the dose of the suspected agent (most commonly Z) if this can be done without compromising the regimen. ​
• Discontinue the suspected agent if this can be done without compromising the regimen.​

Points to Note​

• Symptoms of arthralgia generally diminish over time, even without intervention.​
• Uric acid levels may be elevated in patients on Z. ​
• There is little evidence to support the addition of Allopurinol for arthralgia. However, if gout is present, it should be used.​
• If acute swelling, redness, and warmth are present in a joint, consider aspiration for diagnosis of gout, infections, autoimmune diseases, etc.

Resources

• Guidelines for Programmatic Management of Drug-resistant Tuberculosis in India, March 2021.
• Ready Reckoner for Medical Officer - Adverse Drug Reactions Associated with Anti-TB Drugs Identification and Management, 2019.
• Technical and Operational Guidelines for TB in India, 2016.

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