A “minority” opinion about the diagnosis & treatment of Lyme arthritis

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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