d'Eshougues J R, Delcambre B, Defrance D
Rev Rhum Mal Osteoartic. 1976 Oct;43(10):565-73.
Of all the signs of Whipple's disease, the joint manifestations are among the most constant and the earliest to indicate the enteropathy, appearing long before the digestive and general signs. Essentially they consist of painful, peripheral joint manifestations: either simple arthralgia, or true arthritis differing in the degree of pain, the degree of the clinical signs accompanying the pain, the mode of evolution, and the number and the grouping of the joints affected, thus occurring in numerous clinical forms of which the two principal ones are subacute oligoarthritis with a tendency to migrate and chronic polyarthritis that gives rise to few definitive deformations. The radiographic appearance is usually normal. There is nothing specific about the laboratory aspects of the inflammatory syndrome. Synovial histology may in some cases clarify the diagnosis by demonstration of histiocytes with positive PAS granulations. The axial joint manifestations, which are always associated with the preceding ones, are infrequent and practically limited to unilateral or bilateral sacro-iliac lesions, with little or no clinical expression, that are discovered by standard radiology. Jejunal biopsy can be the key to early diagnosis. The pathogenesis remains obscure. The treatment is the same as for Whipple's disease, long-term antibiotic therapy.
在惠普尔病的所有体征中，关节表现是最常见且最早提示肠道病变的体征之一，早在消化和全身体征出现之前就已出现。其本质上表现为疼痛性外周关节表现：要么是单纯关节痛，要么是真正的关节炎，在疼痛程度、伴随疼痛的临床体征程度、演变方式以及受累关节的数量和分组方面存在差异，因而出现多种临床形式，其中两种主要形式为有迁移倾向的亚急性少关节炎和导致极少确定性畸形的慢性多关节炎。X线表现通常正常。炎症综合征的实验室检查方面没有特异性表现。在某些情况下，滑膜组织学检查可通过显示具有阳性PAS颗粒的组织细胞来明确诊断。轴向关节表现总是与先前的表现相关，很少见，实际上仅限于单侧或双侧骶髂关节病变，临床症状很少或没有，通过标准放射学检查发现。空肠活检可能是早期诊断的关键。发病机制仍不清楚。治疗方法与惠普尔病相同，即长期抗生素治疗。
