Lyme arthritis and post-Lyme disease syndrome
- PMID:12118171
- DOI: 10.1097/00002281-200207000-00008
Lyme arthritis and post-Lyme disease syndrome
Abstract
In the United States, intermittent or chronic mono- or oligoarthritis, particularly affecting the knee, is the most common manifestation of late Lyme disease (LD). Lyme arthritis (LA) can usually be prevented by early treatment of acute LD. However, the erythema migrans rash may go undetected in children and in the dark skin of African Americans, leading to delayed treatment and a relatively increased incidence in LA. Virtually all untreated patients with LA have high levels of serum immunoglobulin G antibodies, and sometimes low levels of immunoglobulin M antibodies, to Borrelia burgdorferi (Bb) by ELISA and Western blot. These responses may persist for many years after antibiotic treatment, and therefore, serologic results do not accurately distinguish between active or past infection. Most patients with LA respond well to standard courses of antibiotic treatment, but a small percentage have persistent knee synovitis, in some cases possibly related to the triggering of intrasynovial autoimmunity. Other patients develop a syndrome of diffuse arthralgia, myalgia, fatigue, and subjective cognitive difficulty during or soon after LD, which persists despite antibiotic treatment. Patients with this post-treatment, post-LD syndrome were recently studied in a placebo-controlled double-blind antibiotic trial. There was no evidence of Borrelial infection in these patients by culture or detection of Bb DNA in blood or spinal fluid. Furthermore, there was no difference in responsiveness of these patients to a 3-month course of antibiotic compared with placebo treatment. Thus, LA caused by active Bb infection, post-treatment LA with persistent knee synovitis and post-LD syndrome are distinct and distinguishable clinical entities.
Similar articles
- Lyme arthritis.Kahan A, Amor B, Menkes CJ.Kahan A, et al.Biomed Pharmacother. 1989;43(6):401-3. doi: 10.1016/0753-3322(89)90236-9.Biomed Pharmacother. 1989.PMID:2686765Review.
- Clinical characteristics and treatment outcome of early Lyme disease in patients with microbiologically confirmed erythema migrans.Smith RP, Schoen RT, Rahn DW, Sikand VK, Nowakowski J, Parenti DL, Holman MS, Persing DH, Steere AC.Smith RP, et al.Ann Intern Med. 2002 Mar 19;136(6):421-8. doi: 10.7326/0003-4819-136-6-200203190-00005.Ann Intern Med. 2002.PMID:11900494Clinical Trial.
- [Diagnosis and treatment of Lyme arthritis].Przytuła L, Gińdzieńska-Sieśkiewicz E, Sierakowski S.Przytuła L, et al.Przegl Epidemiol. 2006;60 Suppl 1:125-30.Przegl Epidemiol. 2006.PMID:16909789Review.Polish.
- Diagnosis, treatment, and prognosis of erythema migrans and Lyme arthritis.Feder HM Jr, Abeles M, Bernstein M, Whitaker-Worth D, Grant-Kels JM.Feder HM Jr, et al.Clin Dermatol. 2006 Nov-Dec;24(6):509-20. doi: 10.1016/j.clindermatol.2006.07.012.Clin Dermatol. 2006.PMID:17113969
- Diagnosis and treatment of Lyme arthritis.Arvikar SL, Steere AC.Arvikar SL, et al.Infect Dis Clin North Am. 2015 Jun;29(2):269-80. doi: 10.1016/j.idc.2015.02.004.Infect Dis Clin North Am. 2015.PMID:25999223Free PMC article.Review.
Cited by
- Persistent synovitis in children with Lyme arthritis: two unusual cases. An immunogenetic approach.Hendrickx G, De Boeck H, Goossens A, Demanet C, Vandenplas Y.Hendrickx G, et al.Eur J Pediatr. 2004 Nov;163(11):646-50. doi: 10.1007/s00431-004-1500-3. Epub 2004 Jul 28.Eur J Pediatr. 2004.PMID:15503133
- The Functional and Molecular Effects of Doxycycline Treatment onBorrelia burgdorferi Phenotype.Caskey JR, Hasenkampf NR, Martin DS, Chouljenko VN, Subramanian R, Cheslock MA, Embers ME.Caskey JR, et al.Front Microbiol. 2019 Apr 18;10:690. doi: 10.3389/fmicb.2019.00690. eCollection 2019.Front Microbiol. 2019.PMID:31057493Free PMC article.
- Efficacy and safety of antibiotic therapy for post-Lyme disease? A systematic review and network meta-analysis.Zhang X, Jiang Y, Chen Y, Yang J, Zhang X, Xing L, Liu A, Bao F.Zhang X, et al.BMC Infect Dis. 2023 Jan 12;23(1):22. doi: 10.1186/s12879-023-07989-4.BMC Infect Dis. 2023.PMID:36635681Free PMC article.
- Ultrasound-guided hip arthrocentesis in a child with hip pain and Fever.Moak JH, Vaughan AJ, Silverberg BA.Moak JH, et al.West J Emerg Med. 2012 Sep;13(4):316-9. doi: 10.5811/westjem.2011.10.6797.West J Emerg Med. 2012.PMID:22942931Free PMC article.
- Generalizability in two clinical trials of Lyme disease.Cameron DJ.Cameron DJ.Epidemiol Perspect Innov. 2006 Oct 17;3:12. doi: 10.1186/1742-5573-3-12.Epidemiol Perspect Innov. 2006.PMID:17044928Free PMC article.
Publication types
MeSH terms
Substances
Related information
Grants and funding
LinkOut - more resources
Full Text Sources
Medical
Research Materials
Miscellaneous