POS0707 BECOMING PATIENTS TREATED FOR WHIPPLE’S DISEASE WITH JOINT INVOLVEMENT
Authors: L. Boulkarra, A. Tison, C. Sarrauste, F. Robin, B. Le Goff, G. Cormier, E. Gervais
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Whipple's disease (WD) is a rare systemic infectious disease caused by the bacterium Tropheryma Whipplei. Rheumatological disorders are often in the foreground, and can mimic chronic inflammatory rheumatism disorder (IRD). In some patients treated for WD, recurrence or persistence of joint symptoms is noted. <h3>Objectives:</h3> The objective of this work is to analyze the income of joint manifestation in WM, its healing, its recurrence or the evolution towards an IRD. <h3>Methods:</h3> A retrospective observational multicenter cohort study was conducted. Patient data were collected in the rheumatology departments of the hospitals of Poitiers, Nantes, Brest, La Roche-Sur-Yon and Rennes. The records studied correspond to the records of patients included in the cohort of the A. Tison (1). Information concerning the patient's history (age, sex, occupation, history of diagnosis of IRD, initiation of specific treatment), method of diagnosis (clinical, histological, microbiological), antibiotic therapy administered, and follow-up (disappearance of symptoms, PCR negative, recurrence, progression to IRD) were analysed. Analysis of the files have been done at 3 times: at 3 to 6th months after the diagnosis, at 12th months after the diagnosis and 18 months after the diagnosis of WM. <h3>Results:</h3> Patients were divided into 4 diagnostic subgroups: •11 patients in the MWC subgroup corresponding to a classical WD with positive Periodic Acid-Shiff (PAS) and/or Immunohistochemistry (IHC) digestive biopsy, •16 patients in the LWD subgroup corresponding to a localized WD at the articular level with positive joint PCR, •4 patients in the MWCOA subgroup corresponding to a classical WD associated with a localized WD at the articular level, •24 patients in the PWD subgroup corresponding to probable WD with joint symptomatology but not meeting the criteria of the other three groups. An initial alternative diagnosis of RIC was made in 69.1% of patients. There is a wide variety of joint symptoms. Oligo-polyarthritis is most often described (60%), followed by inflammatory arthro-myalgia (40%), inflammatory spinal pain (29%), fessalgia and inflammatory pain of the pelvis (18.2%), enthesitic pain (12.7%), and finally monoarthritis in 10.9% of cases, mainly involving the knee. On average, 17.7 months after diagnosis of WD, 10 patients (18.8%) were diagnosed with axial and/or peripheral spondyloarthritis, psoriatic arthritis, rheumatoid arthritis or undifferentiated inflammatory rheumatism. There is no relationship between the diagnostic subgroup and the final diagnosis of IRD. There is no link between healthy carrier status and the final diagnosis of IRD. In all 10 patients, clinical remission of WD was described in 70% of cases, and CRP decay at antibiotic therapy M3-6 was observed in 90% of patients. <h3>Conclusion:</h3> Our work allows a description of the joint involvement of WD as seen by rheumatologists and the analysis of healthy carrier patients in view of the new criteria (2). Nearly 20 percent of patients with WD progress to IRD, which raises the question of the initial combination of MW-IRD or of the initiation of IRD by Tropheryma Whipplei. <h3>REFERENCES:</h3> [1] Tison A, Preuss P, Leleu C, Robin F, Le Pluart A, Vix J, et al. Rheumatological features of Whipple disease. Sci Rep. 10 juin 2021;11(1):12278. [2] Meyer S, Puéchal X, Quesne G, Marques I, Jamet A, Ferroni A. Contribution of PCR to Differential Diagnosis between Patients with Whipple Disease and Tropheryma whipplei Carriers. J Clin Microbiol. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>