Arthritis associated with Whipples disease
Seronegative migratory oligo- or polyarthritis/arthralgia primarily involving large and medium joints (knees, ankles, and wrists) characterized by brief episodic attacks (redness, swelling, pain, and loss of function) lasting a few days in a pattern akin to palindromic rheumatism is associated with Whipple’s disease. Less commonly affected joints are elbows, hips, and shoulders. Small joints of the hands are less frequently involved and never in isolation. Arthritis/arthralgia is the presenting symptom in 60% of the 70% cases reported and is present in 90% of all patients. It does not correlate with intestinal symptoms and can precede the intestinal manifestations in 75% of patients by a mean interval of 6 years. Sacroiliitis is present in 7% and spondylitis in 4% of cases. Joint fluid examination may reveal PAS-positive material; however, joint fluid cultures are negative. In a middle-aged man with a palindromic rheumatism-like presentation, but whose symptoms are resistant to immunosuppressive treatment, Whipple’s disease should be considered. Rarely, patients with prolonged untreated Whipple’s disease may develop radiological evidence of destruction, such as joint space narrowing. These lesions are thought to be due to septic arthritis. Hypertrophic osteoarthropathy is a very rare manifestation of Whipple’s disease. T. whipplei has been implicated in some cases of joint prosthesis infection and diskitis.
