Tuberculosis (TB) continues to be a major public health challenge in both developing and developed countries, with a higher prevalence in most developing nations. According to the WHO's Global Tuberculosis Report 2024, the global TB incidence was approximately 10.8 million new cases, or 134 per 100,000 populations [1]. TB caused an estimated 1.25 million deaths in 2023 and remains the leading cause of mortality in patients with infectious diseases. Although the introduction of anti-tuberculous medications led to a decline in TB cases, many developing nations have seen a resurgence of the disease since 1985. In developed countries, several factors contribute to the increasing incidence of TB, such as immigration from regions with high TB prevalence, an ageing population with comorbidities, a rise in immunocompromised individuals, the spread of multidrug-resistant TB, and various socioeconomic factors. TB incidence is particularly high among individuals with AIDS, where it often serves as the first sign of HIV infection [2].

Extrapulmonary Tuberculosis (EPTB) occurs when Mycobacterium tuberculosis infects organs or tissues besides the lungs. EPTB presents in many forms, affecting all organ systems. Some manifestations, like TB meningitis and TB pericarditis, can be life-threatening, while others, such as pleural and spinal TB, may lead to significant morbidity and long-term disability. EPTB is responsible for 15–20 % of all TB cases in HIV-negative individuals, and this proportion increases to 40–50 % in HIV-positive individuals [3].

There is a reciprocal relationship between TB and rheumatological disorders [Fig. 1]. TB is more likely to develop in people with rheumatological disorders as a result of a dysregulated immune state or drug-induced immunosuppression. Several clinical patterns of musculoskeletal TB have been described, like spondylitis, peripheral arthritis, reactive arthritis or Poncet's disease, osteomyelitis, and soft tissue abscesses [4].

MSKTB constitutes 10 % of the overall incidence of extrapulmonary tuberculosis cases. Spinal Tuberculosis represents 50 % of all skeletal tuberculous diseases. Isolated soft tissue TB is uncommon, while extra-spinal musculoskeletal TB commonly affects large joints (hip and knee) and para-articular regions [5].

This review will discuss the pathophysiology, diagnosis and management of musculoskeletal TB (spinal & extraspinal), Poncet's Disease and Tuberculosis in the era of biological disease-modifying drugs.