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- Title
Tick-Borne Disease Infections and Chronic Musculoskeletal Pain.
- Authors
Zychowski, Diana L.; Alvarez, Carolina; Abernathy, Haley; Giandomenico, Dana; Choudhary, Shailesh K.; Vorobiov, Julia M.; Boyce, Ross M.; Nelson, Amanda E.; Commins, Scott P.
- Abstract
This cross-sectional study examines the prevalence of spotted fever group rickettsiosis, ehrlichiosis, and α-gal syndrome and their association with symptomatic radiographic knee osteoarthritis in adults 45 years or older. Key Points: Question: What is the seroprevalence of Rickettsia, Ehrlichia, and Galactose-α-1,3-galactose (α-gal) antibodies, and is exposure to these tick-borne diseases (TBDs) associated with chronic musculoskeletal symptoms? Findings: In this cross-sectional study of 488 individuals, the weighted point prevalence was approximately 9% for Ehrlichia IgG, 17% for Rickettsia IgG, and 20% for α-gal IgE. Antibodies to these TBDs were not associated with symptomatic radiographic knee osteoarthritis, but individuals with elevated α-gal IgE levels reported higher rates of knee pain, aching, or stiffness. Meaning: Findings from this study suggest that Ehrlichia or Rickettsia seropositivity was not associated with musculoskeletal symptoms but further investigation into the pathogenesis of α-gal syndrome is needed. Importance: Tick-borne diseases (TBDs) other than Lyme disease, such as spotted fever group rickettsiosis, ehrlichiosis, and galactose-α-1,3-galactose (α-gal) syndrome, are an emerging public health issue. Long-term sequelae secondary to Ehrlichia or Rickettsia infection are uncommon; however, musculoskeletal symptoms are often attributed to prior tick exposure. Objective: To evaluate the potential associations between prior exposure to TBDs and musculoskeletal symptoms, including radiographic osteoarthritis. Design, Setting, and Participants: This cross-sectional study analyzed serum samples from the fourth visit (2017-2018) of the Johnston County Osteoarthritis (JoCo OA) project, an ongoing longitudinal, population-based study in Johnston County, North Carolina. Biospecimen testing and analysis were performed between May 2022 and November 2023. Participants in the JoCo OA project are noninstitutionalized White and Black Johnston County residents 45 years or older. Main Outcome and Measures: The primary outcome was seropositivity with Ehrlichia IgG, Rickettsia IgG, and/or α-gal IgE and musculoskeletal symptoms. Secondary outcomes included risk factors associated with elevated α-gal IgE and weighted population point prevalence rates. Participants completed questionnaires, underwent physical assessments, and provided biospecimens for serological testing. Multivariable models were used to estimate associations of interest. Results: Of the 605 participants who completed the fourth visit of the JoCo OA project, 488 (80.7%) had serum samples available for testing. The 488 participants had a median (IQR) age of 72 (68-78) years and included 336 females (68.9%) and 161 Black (33.0%) and 327 White (67.0%) individuals. The overall weighted point prevalence was 8.6% (95% CI, 5.9%-11.3%) for Ehrlichia IgG, 17.1% (95% CI, 12.6%-21.5%) for Rickettsia IgG, and 19.6% (95% CI, 15.3%-23.8%) for α-gal IgE level greater than 0.1 IU/mL. Only α-gal IgE was associated with knee pain, aching or stiffness (mean ratio, 1.30; 95% CI, 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and α-gal were not associated with symptomatic radiographic knee osteoarthritis. Male sex (odds ratio [OR], 2.63; 95% CI, 1.55-4.47), current smoker status (OR, 3.55; 95% CI, 1.38-9.18), and an attached tick bite in the past 5 years (OR, 3.99; 95% CI, 2.22-7.15) were all risk factors that were associated with α-gal IgE level greater than 0.1 IU/mL. Despite only 84 individuals (17.2%) recalling a tick bite in the past 5 years, 178 (36.5%) had evidence of prior tick-borne exposure, suggesting frequent human-tick interactions. Conclusions and Relevance: Results of this cross-sectional study indicate no association between Ehrlichia or Rickettsia seropositivity and chronic musculoskeletal symptoms or osteoarthritis. Further investigation is needed into the pathogenesis of α-gal syndrome and interventions to reduce human-tick interactions.
- Subjects
NORTH Carolina; TICK-borne diseases; CHRONIC pain; RESEARCH; SEROPREVALENCE; PHYSICAL diagnosis; RICKETTSIAL diseases; IMMUNOGLOBULINS; HUMAN research subjects; CONFIDENCE intervals; CROSS-sectional method; SELF-evaluation; RICKETTSIA; BLOOD collection; FISHER exact test; RISK assessment; INFORMED consent (Medical law); MUSCULOSKELETAL pain; OSTEOARTHRITIS; QUESTIONNAIRES; FLUORESCENT antibody technique; DESCRIPTIVE statistics; RESEARCH funding; SOCIODEMOGRAPHIC factors; ODDS ratio; DATA analysis software; EHRLICHIOSIS; DISEASE risk factors; DISEASE complications; SYMPTOMS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe2351418
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.51418