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Persistence of Organisms for Lyme Arthritis
- Jesse L. Goodman, MD
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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.
Jesse L. Goodman, MD
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
