Tuberculous arthritis is still present in the United States and should be included in the differential diagnosis of painful swollen joints. It should be considered even if there is no history of active tuberculosis or if the chest x-ray is negative. Early radiographic changes in the involved joint can be very subtle. The diagnosis of osteoarticular tuberculosis is established by culture of synovial fluid or by histology and/or culture of the synovial tissue. Early drug treatment is effective in preventing joint destruction. We believe that a tuberculin skin test (PPD) should be a routine part of the evaluation of any destructive arthritis and should be performed prior to steroid injection and especially prior to consideration of total joint replacement.