title: [Whipple disease revealed by anti-TNFα therapy].
abstract: BACKGROUND
  Whipple disease is a rare infectious disease with protean clinical manifestations. This infection may mimic chronic inflammatory rheumatisms such as rheumatoid arthritis or spondylarthritis. In this context, introduction of a biotherapy after a diagnostic hesitation does not always lead to early complications. Sometimes, the clinical degradation follows an initial improvement, encouraging continuation of the immunosuppressive treatment and leading consequently to a greater diagnostic delay.
  
  
  METHODS
  We report two cases of Whipple disease diagnosed in the context of an inflammatory disease with anti-TNFα failure. The first patient was a 53-year-old man who presented with an axial and peripheral spondylarthritis who was treated with etanercept and adalimumab. The second was a 42-year-old man who received adalimumab and then etanercept for a peripheral spondylarthritis.
  
  
  CONCLUSIONS
  Whipple disease should be suspected in all patients who present with a chronic inflammatory rheumatism that is partially or not controlled with anti-TNFα therapy and who had persisting elevated acute phase reactants.
authors.affiliation: Service de rhumatologie B, université Paris-Descartes, hôpital Cochin, AP-HP, Paris, France. sparsal@ch-mulhouse.fr
authors.forename: L
authors.initials: L
authors.lastname: Sparsa
authors.forename: F
authors.initials: F
authors.lastname: Fenollar
authors.forename: L
authors.initials: L
authors.lastname: Gossec
authors.forename: J
authors.initials: J
authors.lastname: Leone
authors.forename: J-L
authors.initials: JL
authors.lastname: Pennaforte
authors.forename: M
authors.initials: M
authors.lastname: Dougados
authors.forename: C
authors.initials: C
authors.lastname: Roux
mesh_terms: D000068879:Adalimumab; D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects / Q000627:therapeutic use; D003937:Diagnosis, Differential; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012213:Rheumatic Fever / Q000628:therapy*; D025242:Spondylarthropathies / Q000628:therapy; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D008061:Whipple Disease / Q000175:diagnosis*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab