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Antiphospholipid antibodies in patients with purported ‘chronic Lyme disease’.

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Abstract

BACKGROUND:

Antiphospholipid antibody (aPL) positive patients and patients with purported chronic
Lyme disease (‘CLD’) share many clinical features. After identifying significant aPL in sera of several index patients with ‘CLD’, we performed aPL tests on all patients referred in whom ‘CLD’ was suspected, diagnosed or treated.

METHODS:

All patients with suspected, diagnosed or treated ‘CLD’ and reportedly ‘positive’
Lyme assays were studied. aPL testing included anticardiolipin antibodies (aCL), anti-beta-2-glycoprotein-1 antibodies (anti-?2GP1) and lupus anticoagulant (LAC). Patients were classified into four newly described categories of CLD and data was analyzed.

RESULTS:

One hundred and six patients were evaluated, of whom 82% had neurologic symptoms and 51% rheumatologic symptoms. Eighty-eight of 106 (83%) patients had positive
Lyme serologies (enzyme-linked immunosorbent assay [ELISA] 62/106, 58.4%; western blot [WB] 64/106, 60%), while 18/106 (16.9%) were negative or equivocal. aPL was found in all ‘CLD’ categories. aCL and/or anti-?2GP1 were positive in 85/106 (80%), with aCL present in 69/106 (65%) and anti-?2GP1 present in 69/106 (65%). For all assays, IgM isotypes predominated: WB 55/64 (85%), aCL 63/69 (91%), anti-?2GP1 52/69 (75%), aCL and/or anti-?2GP1 74/85 (87%). Anti-?2GP1 assays occurred in higher titer than aCL: 36/69 (52%) versus 63/69 (91%), p<0.001. Seventeen patients had aPL-related events. Only 12/106 (11.3%) had true post-
Lyme syndromes (PLS), category IV, or late
Lyme disease (LLD). Most patients had been treated for
Lyme: 82/106 (79%).

CONCLUSION:

aPL occurs frequently in patients with ‘CLD’. IgM anti-?2GP1, IgM aCL and IgM WB were frequently found. Documented PLS or LLD was uncommon. The role of aPL in patients with ‘CLD’ needs further investigation.

Lupus. 2011 Nov;20(13):1372-7. doi: 10.1177/0961203311414098. Epub 2011 Jul 5. Case Reports

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