Poncet's Disease or Tubercular Rheumatism

  • Poncet's Disease or Tuberculous rheumatism is poly arthritis with visceral tuberculosis but no bacteriological evidence of joint involvement.
  • The first detailed description of the disease was given by Antonin Poncet in 1897
  • It is different from tuberculous arthritis, which is usually monoarticular and is caused by direct tuberculous infection. Poncet's disease remains a diagnosis of exclusion.
  • There are isolated reports of this disease entity from India and abroad. 
  • The clinical presentation may be primary tuberculosis as the first manifestation or secondary to chest tuberculosis. The pattern of articular involvement is predominantly non-migratory, polyarticular with mild to moderate functional incapacity. Morning stiffness is usually absent. 
  • Response to anti-tubercular treatment with no residual deformity is usually seen.
  • Sterile polyarthritis can some times complicate tuberculosis.
  • Various mechanisms like 
  1. hypersensitivity response to tuberculous protein, 
  2. Increased PPD induced reactivity of synovial fluid lymphocytes compared with that of peripheral blood lymphocyte,
  3. Antigenic similarity between a fraction of tubercle bacilli and human cartilage and circulating immune complexes against synovium have been postulated. 
  4. Presently a cell - mediated cross reactive immune response to Mycobacterium tuberculosis is thought to be the cause of this reactive inflammatory arthropathy of Poncet's disease.

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