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Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease.

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Previous follow-up studies of patients with
Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity.


To determine clinical and functional outcomes in persons who were treated for
Lyme disease in the late 1980s.


Population-based, retrospective cohort study.


Nantucket Island, Massachusetts.


186 persons who had a history of
Lyme disease (case-patients) and 167 persons who did not (controls).


Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-item Short Form Health Survey [SF-36]), mood state assessment (Profile of Mood States), neurocognitive tests, and serologic examination.


The prevalence of
Lyme disease among adults on Nantucket Island was estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous
Lyme disease (mean time from infection to study evaluation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impairment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0.003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P < 0.001) than persons without previous
Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous
Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the performance of the two groups on neurocognitive tests did not significantly differ.


Because persons with previous
Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.

Ann Intern Med. 1999 Dec 21;131(12):919-26. Research Support, Non-U.S. Gov’t; Research Support, U.S. Gov’t, P.H.S.

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