Isolated joint involvement in Whipple's disease: a cohort study

Area of Science:

• Rheumatology
• Infectious Diseases
• Gastroenterology

Background:

• Whipple's disease (WD) is a rare systemic bacterial infection.
• Joint manifestations are common in WD, but isolated joint involvement requires further characterization.
• Comparing clinical isolated joint involvement (CIJI) with systemic joint involvement (SJI) aids in understanding WD's spectrum.

Purpose of the Study:

• To analyze the joint manifestations of Whipple's disease.
• To compare clinical isolated joint involvement (CIJI) with systemic joint involvement (SJI).

Main Methods:

• A cohort study of 60 patients with WD and joint involvement from two expert centers.
• Patients were categorized into CIJI and SJI groups based on clinical presentation at diagnosis.
• Diagnostic methods included PCR (saliva, stool, duodenal, synovial fluid) and PAS staining.

Main Results:

• 17% of patients presented with CIJI; both groups predominantly comprised middle-aged men.
• Joint involvement was similar: episodic migratory arthritis affecting large joints.
• Synovial fluid PCR was highly sensitive (100% in CIJI, 89% in SJI).

Conclusions:

• Whipple's disease can present with isolated articular forms, often as the initial symptom.
• The diagnostic approach should consider typical arthritis patterns in middle-aged men, especially with elevated acute phase reactants.
• Synovial fluid PCR is a valuable diagnostic tool, and doxycycline/hydroxychloroquine therapy leads to significant symptom resolution.