title: Whipple's disease diagnosed during biological treatment for joint disease.
abstract: OBJECTIVE
  Increased susceptibility to infections is among the main safety concerns raised by biological agents. We describe five cases of Whipple's disease diagnosed during treatment with biological agents.
  
  
  METHODS
  We retrospectively identified five cases of Whipple's disease diagnosed between 2003 and 2009 in patients treated with TNFalpha antagonists in five French hospitals.
  
  
  RESULTS
  Five patients (four male; mean age: 50.4 years; range: 38-67) underwent biological therapy according to prior diagnoses of rheumatoid arthritis (n=2), ankylosing spondylitis (n=2), or spondyloarthropathy (n=1). Biological therapy failed to control the disease, which responded to appropriate antibiotics for Whipple's disease. Retrospectively, clinical symptoms before biological therapy were consistent with Whipple's disease. All five patients had favorable outcomes (mean follow-up, 29 months [13-71]).
  
  
  CONCLUSIONS
  Biological therapy probably worsened preexisting Whipple's disease, triggering the visceral disorders. Whipple's disease must be ruled out in patients with joint disease, as patients with this spontaneously fatal condition should not receive immunosuppressive agents.
authors.affiliation: Service de rhumatologie, Inserm U922, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France. emhoppe@chu-angers.fr
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Hoppé
authors.forename: Charles
authors.initials: C
authors.lastname: Masson
authors.forename: Maurice
authors.initials: M
authors.lastname: Audran
authors.forename: Marie
authors.initials: M
authors.lastname: Drillon
authors.forename: Marita
authors.initials: M
authors.lastname: Andreu
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Berthelot
authors.forename: Yves
authors.initials: Y
authors.lastname: Maugars
authors.forename: Ihsane
authors.initials: I
authors.lastname: Hmamouchi
authors.forename: Jacques
authors.initials: J
authors.lastname: Morel
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004318:Doxycycline / Q000009:adverse effects / Q000627:therapeutic use; D000068800:Etanercept; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000009:adverse effects / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012189:Retrospective Studies; D025242:Spondylarthropathies / Q000188:drug therapy*; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D008061:Whipple Disease / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D006886:Hydroxychloroquine; D000069285:Infliximab; D000068879:Adalimumab; D004318:Doxycycline; D000068800:Etanercept