Diagnosis and therapy monitoring of Whipple's arthritis by polymerase chain reaction

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Abstract
Sir, Whipple's disease is a multisystem bacterial infection usually characterized by malabsorption syndrome with diarrhoea and weight loss, low‐grade fever and lymphadenopathy. Arthritis is often the first sign of Whipple's disease and may begin years before typical intestinal manifestations occur. Examination of joint fluid and tissue might therefore provide an opportunity for an early diagnosis. Diagnosis of Whipple's disease is usually established by the presence of periodic acid–Schiff (PAS)‐positive, rod‐shaped inclusions in macrophages of biopsies of the small bowel and other involved tissues and/or the identification of bacteria by electron microscopy. The non‐cultivable Tropheryma whippelii has been identified by the polymerase chain reaction (PCR) based on the 16S‐rRNA gene sequence [1]. Recently, positive PCR tests either of synovial fluid (two patients) or membrane (one patient) were demonstrated in Whipple's disease patients with arthritis [2, 3]. Only in one patient with chronic and erosive arthritis PAS‐positive macrophages were demonstrated in small bowel biopsies. There was no evidence of T. whippelii by PAS staining or by PCR testing in the upper gastrointestinal tract in the other two cases. No post‐treatment examinations of joint specimens have been reported. Similarly, patients with Whipple's endocarditis negative in histopathology and by PCR in duodenal biopsies have been described recently [4].

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