Abstract：
OBJECTIVE: 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.
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.
摘要：
目的：毛发红斑感染可表现为关节炎症症状，这可能导致炎症性风湿性疾病的误诊和使用改善疾病的抗风湿药物。我们调查了炎症性风湿性疾病患者的诊断和治疗的影响。
方法：我们启动了一项登记，纳入了接受抗风湿药治疗的炎症性风湿性疾病患者，这些患者随后被诊断为鞭毛性红斑狼疮感染。我们收集了临床，生物，炎症性风湿性疾病的治疗数据，鞭毛虫感染，抗生素对炎症性风湿性疾病演变的影响。
结果：在73名炎性风湿性疾病患者中，改善疾病的抗风湿药开始引发27％的关节外表现，并导致稳定（51％），恶化（34%），或改善（15％）的炎症性风湿性疾病。在诊断为鞭毛虫感染时，所有患者均有风湿病症状（平均年龄58岁，中位炎症性风湿病持续时间79个月)，84%有风湿病外表现,93%有C反应蛋白升高,86%有低蛋白血症。鞭毛红斑感染的治疗主要包括多西环素加羟氯喹，导致79％的病例缓解了鞭毛虫感染。在93％的病例中，Tropherymawhipplii感染的抗生素治疗与炎症性风湿性疾病的缓解有关，并且在大多数病例中可以使用改善疾病的抗风湿药物和糖皮质激素停药。
结论：在有关节外表现的炎症性风湿性疾病患者中，应考虑并发性红斑感染。C反应蛋白升高，和/或在疾病改善抗风湿药开始之前或在对一种或多种疾病改善抗风湿药反应不足的炎性风湿性疾病患者中的低白蛋白血症。whipplii红斑感染的筛查和诊断测试的阳性结果涉及抗生素治疗，这与鞭毛红斑感染的完全恢复和炎症性风湿性疾病的快速缓解有关，允许缓解疾病的抗风湿药物和糖皮质激素停药。
背景：没有。
方法：我们启动了一项登记，纳入了接受抗风湿药治疗的炎症性风湿性疾病患者，这些患者随后被诊断为鞭毛性红斑狼疮感染。我们收集了临床，生物，炎症性风湿性疾病的治疗数据，鞭毛虫感染，抗生素对炎症性风湿性疾病演变的影响。
结果：在73名炎性风湿性疾病患者中，改善疾病的抗风湿药开始引发27％的关节外表现，并导致稳定（51％），恶化（34%），或改善（15％）的炎症性风湿性疾病。在诊断为鞭毛虫感染时，所有患者均有风湿病症状（平均年龄58岁，中位炎症性风湿病持续时间79个月)，84%有风湿病外表现,93%有C反应蛋白升高,86%有低蛋白血症。鞭毛红斑感染的治疗主要包括多西环素加羟氯喹，导致79％的病例缓解了鞭毛虫感染。在93％的病例中，Tropherymawhipplii感染的抗生素治疗与炎症性风湿性疾病的缓解有关，并且在大多数病例中可以使用改善疾病的抗风湿药物和糖皮质激素停药。
结论：在有关节外表现的炎症性风湿性疾病患者中，应考虑并发性红斑感染。C反应蛋白升高，和/或在疾病改善抗风湿药开始之前或在对一种或多种疾病改善抗风湿药反应不足的炎性风湿性疾病患者中的低白蛋白血症。whipplii红斑感染的筛查和诊断测试的阳性结果涉及抗生素治疗，这与鞭毛红斑感染的完全恢复和炎症性风湿性疾病的快速缓解有关，允许缓解疾病的抗风湿药物和糖皮质激素停药。
背景：没有。
