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Whipple's arthritis.

Abstract : Please check your proof carefully and mark all corrections at the appropriate place in the proof (e.g., by using on-screen annotation in the PDF file) or compile them in a separate list. Note: if you opt to annotate the file with software other than Adobe Reader then please also highlight the appropriate place in the PDF file. To ensure fast publication of your paper please return your corrections within 48 hours. For correction or revision of any artwork, please consult Any queries or remarks that have arisen during the processing of your manuscript are listed below and highlighted by flags in the proof. Click on the 'Q' link to go to the location in the proof. Location in Query / Remark: click on the Q link to go article Please insert your reply or correction at the corresponding line in the proof Q1 The author names have been tagged as given names and surnames (surnames are highlighted in teal color). a b s t r a c t Whipple's disease is a chronic systemic infection that is due to the bacterial agent Tropheryma whipplei and can be cured by appropriate antibiotic therapy. The typical patient is a middle-aged man. Rheuma-tologists are in a prime position to handle Whipple's disease. The classical presentation combines weight loss and diarrhea, preceded in three-quarters of patients by a distinctive pattern of joint manifestations that run an intermittent course, at least initially. The mean time from joint symptom onset to the diagnosis of Whipple's disease is 6 years. Either oligoarthritis or chronic polyarthritis with negative tests for rheumatoid factors (RFs) develops. If the diagnosis is missed, progression to chronic septic destructive polyarthritis may occur. Spondyloarthritis has also been reported, as well as a few cases of diskitis or, even more rarely, of hypertrophic osteoarthropathy. In most patients with the classical form of Whipple's disease, periodic acid-Schiff (PAS) staining of duodenal and jejunal biopsies shows macrophagic inclusions that contain bacteria. However, the involvement of the bowel may be undetectable clinically or, less often, histologically, and even PCR testing of bowel biopsies may be negative. Therefore, when nothing points to bowel disease, rheumatologists should consider T. whipplei infection in middle-aged men with unexplained intermittent oligoarthritis. PCR testing allows the detection of T. whipplei genetic material in joint fluid, saliva, and feces. This test is now a first-line diagnostic investigation, although T. whipplei is a rare cause of unexplained RF-negative oligoarthritis or polyarthritis in males. PCR testing can provide an early diagnosis before the development of severe systemic complications, which are still fatal in some cases. © 2016 Published by Elsevier Masson SAS on behalf of Socí et e franç aise de rhumatologie.
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Contributor : Xavier Puéchal Connect in order to contact the contributor
Submitted on : Wednesday, September 21, 2016 - 1:39:24 PM
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Xavier Puéchal. Whipple's arthritis.. Joint Bone Spine, Elsevier Masson, 2016, ⟨10.1016/j.jbspin.2016.07.001⟩. ⟨inserm-01369684⟩



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