After reading Reid and colleagues' report [1], I came away with a feeling of "Enough already!"

The authors' stated objective was to identify the complications of patients who had been inappropriately diagnosed and treated for Lyme disease. Did any of the authors also evaluate patients in the Yale University Lyme Disease Clinic during the study? The stated objective would certainly affect the physicians' objectivity in evaluating patients' Lyme disease status.

What data show that continued antibiotic therapy does not help with the fatigue-arthralgia-myalgia syndrome? In my review of the literature, the only prospective study evaluating patients with post-Lyme disease fibromyalgia-like syndromes and their response to appropriate courses of antibiotics for Lyme disease was an observational study involving 15 participants [2]. An intriguing finding was that 10 of 14 (71%) of their patients who received antibiotics responded and then relapsed after antibiotic therapy was stopped. Why was this interpreted as an antibiotic failure or simply a placebo effect? Perhaps these patients did not receive the right amount of the right antibiotic. In a recently published study, albeit a retrospective and observational one, patients with similar fibromyalgia-type symptoms after Lyme disease seemed to be helped by prolonged tetracycline therapy (1 to 11 months) [3]. Obviously, there is a lack of randomized, controlled trials of antibiotics for fibromyalgia-like syndromes complicating Lyme disease.

Within Reid and colleagues' category of previous but no active Lyme disease, 8% of patients received a diagnosis of peripheral neuropathy. Because chronic peripheral neuropathies are a well-documented active complication of Lyme disease [4] that responds to antibiotics, it's important to know more about these patients.

Sixty-one percent of patients in the category of "no evidence of Lyme disease" had a previously positive Lyme titer recorded in another laboratory (but not confirmed in the authors' laboratory). Where was this testing done, and were the results of enzyme-linked immunosorbent assay confirmed by Western blots? What are the authors' explanations for this marked lack of correlation other than lack of standardization? Have false-negative results on Lyme serologic testing come from the authors' laboratory with well-documented Lyme disease?

Accepted "guidelines" for treatment of Lyme disease [5], cited in Reid and colleagues' study as "appropriate" therapy, were clearly considered by the guideline's authors as "preliminary" with "large areas of uncertainty." They even caution that these guidelines "should always be applied with close attention to the clinical course of individual patients." We need prospective, well-designed studies addressing the treatment of patients with persistent symptoms after Lyme disease.