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- Title
Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease.
- Authors
Arvikar, Sheila L.; Crowley, Jameson T.; Sulka, Katherine B.; Steere, Allen C.
- Abstract
Objective To describe systemic autoimmune joint diseases that develop following Lyme disease, and to compare their clinical features with those of Lyme arthritis (LA). Methods We reviewed records of all adult patients referred to our LA clinic over a 13-year period, in whom we had diagnosed a systemic autoimmune joint disease following Lyme disease. For comparison, records of patients enrolled in our LA cohort over the most recent 2-year period were analyzed. Levels of IgG antibodies to Borrelia burgdorferi and to 3 Lyme disease-associated autoantigens were measured. Results We identified 30 patients who had developed a new-onset systemic autoimmune joint disorder a median of 4 months after Lyme disease (usually manifested by erythema migrans [EM]). Fifteen had rheumatoid arthritis (RA), 13 had psoriatic arthritis (PsA), and 2 had peripheral spondyloarthritis (SpA). The 30 patients typically had polyarthritis, and those with PsA or SpA often had previous psoriasis, axial involvement, or enthesitis. In the comparison group of 43 patients with LA, the usual clinical picture was monoarticular knee arthritis, without prior EM. Most of the patients with systemic autoimmune joint disorders were positive for B burgdorferi IgG antibodies, as detected by enzyme-linked immunosorbent assay, but had significantly lower titers and lower frequencies of Lyme disease-associated autoantibodies than patients with LA. Prior to our evaluation, these patients had often received additional antibiotics for presumed LA, without benefit. We prescribed antiinflammatory agents, most commonly disease-modifying antirheumatic drugs, resulting in improvement. Conclusion Systemic autoimmune joint diseases (i.e., RA, PsA, SpA) may follow Lyme disease. Development of polyarthritis after antibiotic-treated EM, previous psoriasis, or low-titer B burgdorferi antibodies may provide insight into the correct diagnosis.
- Subjects
MASSACHUSETTS; ANTIGEN analysis; DRUG therapy for arthritis; AUTOANTIBODY analysis; AUTOIMMUNE disease diagnosis; RHEUMATOID arthritis diagnosis; PSORIATIC arthritis; IMMUNOGLOBULIN analysis; ANTI-inflammatory agents; ANTIBIOTICS; ANTIRHEUMATIC agents; ARTHRITIS; ENZYME-linked immunosorbent assay; ERYTHEMA; FISHER exact test; GRAM-negative bacteria; JOINT diseases; LYME disease; PROBABILITY theory; RESEARCH funding; T-test (Statistics); WESTERN immunoblotting; DESCRIPTIVE statistics; MANN Whitney U Test; ONE-way analysis of variance; DISEASE complications; DIAGNOSIS
- Publication
Arthritis & Rheumatology, 2017, Vol 69, Issue 1, p194
- ISSN
2326-5191
- Publication type
Article
- DOI
10.1002/art.39866