The Long-Term Clinical Outcomes of Lyme Disease: A Population-Based Retrospective Cohort Study

  1. Nancy A. Shadick, MD, MPOH;
  2. Charlotte B. Phillips, MPH;
  3. Eric L. Logigian, MD;
  4. Allen C. Steere, MD;
  5. Richard F. Kaplan, PhD;
  6. Victor P. Berardi, AB;
  7. Paul H. Duray, MD;
  8. Martin G. Larson, ScD;
  9. Elizabeth A. Wright, PhD;
  10. Katherine S. Ginsburg*, MD, MPH;
  11. Jeffrey N. Katz, MD, MS; and
  12. Matthew H. Liang, MD, MPH
  1. Requests for Reprints: Nancy A. Shadick, MD, MPH, Department of Rheumatology-Immunology, PB2, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. Acknowledgments: The authors thank Catherine Lastavica, MD, for her epidemiologic and clinical advice; Richard Shadick, PhD, for his assistance with the neuropsychological training and testing; and Geoffrey Ginsburg, MD, for his clinical advice. Grant Support: In part by National Institutes for Health grants AR36308, AR20358, and AR07530. Dr. Shadick is supported by an Arthritis Foundation Postdoctoral Fellowship. Dr. Katz is supported by an Arthritis Foundation Investigator Award.

    Abstract

    Objective: To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.

    Design: Population-based, retrospective cohort study.

    Setting: A coastal region endemic for Lyme disease.

    Participants: Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.

    Measurements: A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.

    Results: Compared with the control group (n = 43), the Lyme group (n = 38; mean duration from disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment (n = 4), and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).

    Conclusions: Persons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.

    *Deceased.

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    1. Ann Intern Med October 15, 1994 vol. 121 no. 8 560-567
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