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Whipple's disease diagnosed during biological treatment for joint disease

Emmanuel Hoppé1, Charles Masson, Maurice Audran

  • 1Service de rhumatologie, Inserm U922, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France. emhoppe@chu-angers.fr

Joint Bone Spine
|May 18, 2010
PubMed
Abstract

Insights

Biological therapy may worsen pre-existing Whipple's disease, a serious infection. Patients with joint disease should be screened for Whipple's disease before starting immunosuppressive treatments.

Area of Science:

  • Infectious Diseases
  • Rheumatology
  • Immunology

Background:

  • Biological agents, particularly TNFalpha antagonists, are used for autoimmune diseases.
  • Increased infection susceptibility is a known risk with immunosuppressive therapies.

Observation:

  • Five cases of Whipple's disease were diagnosed in patients receiving TNFalpha antagonists.
  • Patients had prior diagnoses of rheumatoid arthritis, ankylosing spondylitis, or spondyloarthropathy.

Findings:

  • Biological therapy did not improve the underlying condition and may have exacerbated Whipple's disease.
  • Prompt antibiotic treatment led to favorable outcomes in all patients.
  • Retrospective analysis revealed symptoms consistent with Whipple's disease prior to biological therapy.

Implications:

  • Whipple's disease should be considered and ruled out in patients with joint diseases before initiating immunosuppressive therapy.
  • Undiagnosed Whipple's disease can be fatal if treated with immunosuppressants.
  • Early diagnosis and appropriate antibiotic treatment are crucial for managing Whipple's disease.

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