[Joint manifestations of Whipple's disease]

Of all the signs of Whipple's disease, the joint manifestations are among the most constant and the earliest to indicate the enteropathy, appearing long before the digestive and general signs. Essentially they consist of painful, peripheral joint manifestations: either simple arthralgia, or true arthritis differing in the degree of pain, the degree of the clinical signs accompanying the pain, the mode of evolution, and the number and the grouping of the joints affected, thus occurring in numerous clinical forms of which the two principal ones are subacute oligoarthritis with a tendency to migrate and chronic polyarthritis that gives rise to few definitive deformations. The radiographic appearance is usually normal. There is nothing specific about the laboratory aspects of the inflammatory syndrome. Synovial histology may in some cases clarify the diagnosis by demonstration of histiocytes with positive PAS granulations. The axial joint manifestations, which are always associated with the preceding ones, are infrequent and practically limited to unilateral or bilateral sacro-iliac lesions, with little or no clinical expression, that are discovered by standard radiology. Jejunal biopsy can be the key to early diagnosis. The pathogenesis remains obscure. The treatment is the same as for Whipple's disease, long-term antibiotic therapy.