Skip to main content

Table 1 Reports indicating alteration of the course of subacute Whipple’s disease during therapy with biological agents

From: Arthralgia and blood culture-negative endocarditis in middle Age Men suggest tropheryma whipplei infection: report of two cases and review of the literature

Nr. Reports Indicating Potential Fatal Complications Of Biological Therapy During Sero-negative Rheumatoid Arthritis.
  Author Journal Yr of Pub Nr. of Pat. Initial symptoms/Duration Therapy Results Conclusion/Finding
[20] Mahnel R. et al. Am. J. Gastroenterol. 2005 27     Immunosuppressiva lead to earlier onset of diarrhea
[21] Kneitz C. et al. Scand. J. Rheumatol. 2005 1   Infliximab/MTX Rapid weight loss Erythema nodosum diarrhea LN enlargement sigmoido-vesical fistula Infliximab seems to increase the risk of exacerbation of WD
[22] Razonable R.R. et al. Transpl. Infect. Dis. 2008 1 Kidney Transplant and migratory poly arthritis, weight loss, GIT-symptoms for years Azathioprim/Prednison Chorioretinitis and Vitreitis Tropheryma whipplei DNA in vitrous fluid and peripheral blood
[23] Kremer AE. et al. Z. Gastroenterolog. 2008 1 SNRA/4 yrs Adalimumab/Leflunomid Septic fever severe arthralgia weight loss Immunmodulatory therapies, TNF blockers and Corticosteroids may lead to exercerbation of subacute, undiagnosed Whipples Disease
[24] Spoerl D. et al. Orphanet. J. Rare Dis. 2009 1 Multisegment spondylitis TNF-a Worsening back pain TNF-a treatment worsened spondylodiscitis, leading to diagnosis of T. Whipplei from rebiopsy of vertebral specimen
[25] Lagier J-C et al. Medicine 2010 113 5 of 16 patients with endocarditis as initial symptoms had immunosuppressive treatment Corticosteroids 50 (43 %) TNF-a antagonists 16 (14 %) Others 16 (14 %) Previous immuno suppressive Treatment 56 (50 %) 32 patients (28 %) experienced aggravation of various symptoms after immunosuppressive therapy Patients with inflammatory rheumatoid disease who experience severe general involvment should be screened for T. Whippelii or the therapy is inneffective against polyarthritis
[26] Hoppe E. et al. Joint bone Spine 2010 5 RA(2), AS(2), SA(1) TNF a antagonists Failure to control the disease and other symptoms Biological therapy probably worsened pre existing whipples disease
[27] Vancsa A et al. Joint Bone Spine 2010 1 Seronegative Oligoarthritis Eternecept Endocarditis DMARDs resistant arthritis should prompt thourough search T.whippelii prior to initiation of TNF-a antagonists
[28] Hmamouci I et al. J. Rheumatol. 2010 1 Ankylosing spondylitis Eternecept Scurvy Eternecept probably modified the cytokine environment and thus favoured exercerbation of whipples disease
[29] Daien C.I. et al. Rheumatology 2010 1 B-27- negative Ankylosing spondylitis Eternecept Endocarditis Report of the first case of t. Whippeliis endocarditis, potentially induced by TNF-a antagonist therapy
[30] Gaddy J.R. Rheumatology 2012 1 Back pain; Arthritis Various TNF a Inhibitors Fever, migratory arthritis Clinical deterioration despite TNF a antagonists lead to thorough search and T. Whipelli was found
[31] Sparsa L et al. La Revue de medecine interne 2013 2 Spondyloarthritis (both patients) Eternecept/adalimumab (Both patients) peristent elevated acute phase reactants Whipples disease should be suspected in patients with treated with TNF a antagonists who do not improve during inflammatory rheumatism
[32] Marth T. World J. Cardiol. 2014 41vs 61vs1059 Arthritis TNF-a/41 patients 12.2 % vs 1.6 % vs 0.16 % endocarditis rates TNF-a triggered severe whipples disease complications particularly endocarditis
[33] Marth T. Aliment. Pharmacol. Ther. 2015 41 Arthritis, weight-loss, Diarrhea Various TNF-a Inhibitors Fever, septic temperatures (n, 16), Tropheryma whipplei septicemia (n, 6), Endocarditis (n, 5) etc. In case of doubt, Whipples disease should be excluded before therapy with TNF-a