REPLY
Persistence of Organisms for Lyme Arthritis
Jesse L. Goodman, MD
1 September 1994 | Volume 121 Issue 5 | Pages 383-384
IN RESPONSE:
Dr. Patmas raises the concern that patients with chronic, persistent symptoms after therapy for Lyme disease may have continuing infection rather than syndromes such as fibromyalgia, which have been considered noninfectious or postinfectious.
Our study clearly showed a role for persistent spirochetes in the pathogenesis of Lyme arthritis and included some patients treated with antibiotics. Arthritis (and polymerase chain reaction positivity for Borrelia burgdorferi) were seen in two patients (Patients 5 and 12) who had received several months of therapy with oral doxycycline. Arthritis that was positive for B. burgdorferi by polymerase chain reaction was also noted in one patient (Patient 5) despite previous treatment of erythema migrans with tetracycline. Similar apparent clinical failures of tetracycline have also been reported [6]. However, most patients treated appropriately for erythema migrans do not develop such late complications [7], and most patients treated with antibiotics have negative skin biopsy cultures after therapy [8].
Our study specifically addressed the role of spirochetal persistence only in patients with objective arthritis. Because cultures were negative, it remains to be proven that the detection of DNA indicates the presence of live organisms. The responses to subsequent antibiotic therapy, however, support the notion that living organisms do persist in such persons.
Our results in patients with arthritis raise the possibility that such persistence may play a role in disease pathogenesis in other subgroups with Lyme disease whose symptoms persist after therapy. However, no proof exists that patients with persisting subjective neurologic and musculoskeletal symptoms (with or without fatigue) have ongoing infection. Further studies are warranted regarding both the causes of and the best treatments for such problems.
1. Dattwyler RJ, Halperin JJ. Failure of tetracycline therapy in early Lyme disease. Arthritis Rheum. 1987; 30:448-50.
2. Steere AC, Hutchinson GJ, Rahn DW, Sigal LH, Craft JE, DeSanna ET, et al. The early clinical manifestations of Lyme disease. Ann Intern Med. 1983; 99:22-6.
3. Berger BW, Johnson RC, Kodner C, Coleman L. Failure of Borrelia burgdorferi to survive in the skin of patients with antibiotic-treated Lyme disease. J Am Acad Dermatol. 1992; 27:34-7.
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