Clinical characteristics of the arthritis associated with Whipple disease
Whipple disease occurs most commonly in middle-aged white men (male/female ratio, 8:1). Seronegative oligoarthritis or polyarthritis (knees, ankles, wrists) is the presenting symptom in 60% of patients and may precede the intestinal symptoms by up to 5 years. More than 70% of patients will develop arthritis at some time during their disease course. The arthritis is inflammatory, is often migratory, and does not correlate with intestinal symptoms. Sacroiliitis or spondylitis occurs in 5% to 10% of patients, especially in those who are HLA-B27 positive (33% of patients). Synovial fluid analysis shows an inflammatory fluid with 5000 to 100,000 cells/mm 3 (predominantly neutrophils). Radiographs usually remain unremarkable.