Diagnosis and treatment of Tropheryma whipplei infection in patients with inflammatory rheumatic disease: Data from the French Tw-IRD registry - 03/02/24
, Xavier Puéchal b, c, 1, Maëva Masson a, Marie Kostine d, Alexia Michaut e, André Ramon f, Daniel Wendling g, 2, Nathalie Costedoat-Chalumeau b, c, Pascal Richette h, Hubert Marotte i, Justine Vix-Portet j, Jean-Jacques Dubost k, Sébastien Ottaviani l, Gaël Mouterde m, Anne Grasland n, Aline Frazier h, Vincent Germain o, Fabienne Coury p, Anne Tournadre k, Martin Soubrier k, Laurent Cavalie q, Pauline Brevet r, Laurent Zabraniecki a, Bénédicte Jamard a, Guillaume Couture a, Laurent Arnaud s, Christophe Richez d, Yannick Degboé a, Adeline Ruyssen-witrand a, t, Arnaud Constantin a, ⁎ Summary |
Objectives |
Tropheryma whipplei infection can manifest as inflammatory joint symptoms, which can lead to misdiagnosis of inflammatory rheumatic disease and the use of disease-modifying antirheumatic drugs. We investigated the impact of diagnosis and treatment of Tropheryma whipplei infection in patients with inflammatory rheumatic disease.
Methods |
We initiated a registry including patients with disease-modifying antirheumatic drugs-treated inflammatory rheumatic disease who were subsequently diagnosed with Tropheryma whipplei infection. We collected clinical, biological, treatment data of the inflammatory rheumatic disease, of Tropheryma whipplei infection, and impact of antibiotics on the evolution of inflammatory rheumatic disease.
Results |
Among 73 inflammatory rheumatic disease patients, disease-modifying antirheumatic drugs initiation triggered extra-articular manifestations in 27% and resulted in stabilisation (51%), worsening (34%), or improvement (15%) of inflammatory rheumatic disease. At the diagnosis of Tropheryma whipplei infection, all patients had rheumatological symptoms (mean age 58 years, median inflammatory rheumatic disease duration 79 months), 84% had extra-rheumatological manifestations, 93% had elevated C-reactive protein, and 86% had hypoalbuminemia. Treatment of Tropheryma whipplei infection consisted mainly of doxycycline plus hydroxychloroquine, leading to remission of Tropheryma whipplei infection in 79% of cases. Antibiotic treatment of Tropheryma whipplei infection was associated with remission of inflammatory rheumatic disease in 93% of cases and enabled disease-modifying antirheumatic drugs and glucocorticoid discontinuation in most cases.
Conclusions |
Tropheryma whipplei infection should be considered in inflammatory rheumatic disease patients with extra-articular manifestations, elevated C-reactive protein, and/or hypoalbuminemia before disease-modifying antirheumatic drugs initiation or in inflammatory rheumatic disease patients with an inadequate response to one or more disease-modifying antirheumatic drugs. Positive results of screening and diagnostic tests for Tropheryma whipplei infection involve antibiotic treatment, which is associated with complete recovery of Tropheryma whipplei infection and rapid remission of inflammatory rheumatic disease, allowing disease-modifying antirheumatic drugs and glucocorticoid discontinuation.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Tropheryma whipplei infections often present with inflammatory joint symptoms. |
• | These symptoms may lead to misdiagnosis of inflammatory rheumatic diseases. |
• | T. whipplei infection should be considered in patients with extra-articular manifestations, elevated CRP or hypoalbuminemia. |
• | T. whipplei infection should be considered in patients with an inadequate response to disease-modifying antirheumatic drugs. |
• | Antibiotic treatment of T. whipplei is associated with rapid remission of misdiagnosed inflammatory rheumatic diseases. |
Keywords : Tropheryma whipplei, Whipple disease, Inflammatory rheumatic diseases
Plan
Vol 88 - N° 2
P. 132-138 - février 2024 Retour au numéro
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