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A "minority" opinion about the diagnosis & treatment of Lyme arthritis

  [ 32 votes ]   [ Discuss This Article ] • January 15, 1996

Historically, arthritis was the main symptom which led to the
description of the disease called Lyme borreliosis. However, a
relatively high awareness of doctors and patients of
tick-borne diseases seems to cause a trend to frequently
diagnose this antibiotic-sensitive disease. A case can be
defined as borreliosis only if either the typical erythema
migrans is reliably identified by a physician or if a
characteristic late manifestation of Lyme disease is
accompanied by unequivocal serological and/or bacteriological
evidence of Borrelia infection. Within the musculoskeletal
system, the only reliably characteristic symptom is true
synovitis, as defined by the palpable swelling of a joint.
Mere joint pain or the subjective pain syndrome of
fibromyalgia do not constitute a defining symptom for
borreliosis. An evaluation of the frequency of
Borrelia-associated arthritis in our Viennese rheumatology
outpatient clinic revealed only six well-defined cases among
1,673 subsequent referrals. Based on "serological" suspicion,
the question had been asked about possible borreliosis in 87
of these patients. In order to avoid unnecessary anxiety
about possible long-term complications of Lyme disease among
(actually misdiagnosed) patients, the diagnosis of Lyme
arthritis should only be made according to the stringent
criteria mentioned above. The antibiotic treatment, which is
given to many questionable cases of borreliosis ex
iuvantibus, although possibly of benefit to a few cases of
otherwise undiagnosed reactive arthritis due to infections
with microbes other than Borrelia burgdorferi, has to be
termed irrational.

Graninger W

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