Chronic Lyme Arthritis

doi:10.1059/0003-4819-90-6-896

Chronic Lyme Arthritis

Clinical and Immunogenetic Differentiation from Rheumatoid Arthritis

New Haven, Connecticut; and New York, New York

Abstract

Ten patients with Lyme arthritis have developed chronic involvement of one or both knees. Lyme arthritis was diagnosed by onset with erythema chronicum migrans (six patients); residence in Lyme, Connecticut (eight); seasonal onset in summer and early fall (nine); early periods of short recurrent attacks (nine); absence of rheumatoid factor (nine); and absence of symmetrical polyarthritis, morning stiffness, subcutaneous nodules, or antinuclear antibodies (in all). Five patients had synovectomies; pannus formation and underlying cartilage erosion were present in all. Seven of the 10 patients had the same B-cell alloantigen, DRw2 (frequency in normal control subjects, 22%[ P< 0.005]), but did not have an increased frequency of the alloantigens associated with rheumatoid arthritis. Chronic Lyme arthritis, the result of an apparent tick-transmitted infection, resembles rheumatoid arthritis pathologically but generally differs from it in both prearticular and immunogenetic characteristics.

Article and Author Information

▸From the Departments of Internal Medicine, Epidemiology, and Public Health, Yale University School of Medicine, New Haven, Connecticut; and The Rockefeller University, New York, New York.
These investigations were supported in part by U.S. Public Health Service grants AM-20358, AM-10493, AM-07107, AM-5639, RR-05443, RR-00125, A1-00216, and CA-20107; the Arthritis Foundation and its Connecticut Chapter; the Kroc Foundation of Santa Ynez, California; and the Colombian National Science Foundation (Col Sciencias 140-3-37-77).
Parts of this work have appeared in abstract form in Clin Res 27:338A, April 1979 (STEERE AC, GIBOFSKY A, WINCHESTER RJ, MALAWISTA, SE: Persistent Lyme arthritis with pannus formation and cartilage erosion: clinical and immunogenetic differentiation from rheumatoid arthritis).
▸Requests for reprints should be addressed to Allen C. Steere, M.D.; Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street; New Haven, CT 06510.
- Received September 29, 1978.
- Accepted March 8, 1979.