Lyme disease and Whipple’s disease: a comprehensive review for the rheumatologist

IF 2 4区 医学 Q3 RHEUMATOLOGY
Henrique Ayres Mayrink Giardini, Fabricio Souza Neves, Ivanio Alves Pereira, Rafael Alves Cordeiro
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Abstract

Despite their rarity, Lyme disease and Whipple’s disease are of significant importance in rheumatology, as both can manifest as chronic arthritis, presenting challenges in the differential diagnosis of inflammatory arthropathies. In Lyme disease, arthritis typically emerges as a late manifestation, usually occurring six months after the onset of erythema migrans. The predominant presentation involves mono- or oligoarthritis of large joints, with a chronic or remitting-recurrent course. Even with appropriate antimicrobial treatment, arthritis may persist due to inadequate immunological control triggered by the disease. In contrast, Whipple’s disease may present with a migratory and intermittent seronegative poly- or oligoarthritis of large joints, preceding classic gastrointestinal symptoms by several years. Both disorders, particularly Whipple’s disease, can be misdiagnosed as more common autoimmune rheumatic conditions such as rheumatoid arthritis and spondyloarthritis. Epidemiology is crucial in suspecting and diagnosing Lyme disease, as the condition is transmitted by ticks prevalent in specific areas of the United States, Europe, and Asia. On the contrary, the causative agent of Whipple’s disease is widespread in the environment, yet invasive disease is rare and likely dependent on host genetic factors. In addition to erythema migrans in Lyme disease and gastrointestinal manifestations in Whipple’s disease, neurological and cardiac involvement can further complicate the course of both. This article offers a comprehensive review of the epidemiological, pathophysiological, clinical, and therapeutic aspects of both diseases.
莱姆病与威普尔氏病:风湿病学家的全面回顾
莱姆病和惠普尔病尽管罕见,但在风湿病学中却具有重要意义,因为这两种疾病都可以表现为慢性关节炎,给炎症性关节病的鉴别诊断带来了挑战。在莱姆病中,关节炎通常是晚期表现,通常在迁延性红斑发病后六个月出现。主要表现为大关节的单关节炎或少关节炎,病程为慢性或缓解-复发。即使接受了适当的抗菌治疗,由于疾病引发的免疫控制不足,关节炎仍可能持续存在。相反,Whipple's 病可能表现为迁延性和间歇性血清阴性大关节多关节炎或少关节炎,比典型的胃肠道症状早数年。这两种疾病,尤其是惠普尔病,都可能被误诊为更常见的自身免疫性风湿病,如类风湿性关节炎和脊柱关节炎。流行病学是怀疑和诊断莱姆病的关键,因为该病是由流行于美国、欧洲和亚洲特定地区的蜱传播的。相反,惠普尔病的病原体在环境中广泛存在,但侵入性疾病却很少见,而且很可能取决于宿主的遗传因素。除了莱姆病的迁徙性红斑和惠普尔病的胃肠道表现外,神经系统和心脏受累也会使两者的病程进一步复杂化。本文对这两种疾病的流行病学、病理生理学、临床和治疗方面进行了全面综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Advances in Rheumatology
Advances in Rheumatology Medicine-Rheumatology
CiteScore
4.00
自引率
4.30%
发文量
41
审稿时长
53 weeks
期刊介绍: Formerly named Revista Brasileira de Reumatologia, the journal is celebrating its 60th year of publication. Advances in Rheumatology is an international, open access journal publishing pre-clinical, translational and clinical studies on all aspects of paediatric and adult rheumatic diseases, including degenerative, inflammatory and autoimmune conditions. The journal is the official publication of the Brazilian Society of Rheumatology and welcomes original research (including systematic reviews and meta-analyses), literature reviews, guidelines and letters arising from published material.
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