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Lyme disease is a major clinical problem in a number of endemic areas in the United States. In areas where anxiety about the
disease is high, patients and physicians often ascribe clinical concerns to
Lyme disease. Incorrect diagnosis often leads to unnecessary antibiotic treatment (often prolonged or repeated intravenous therapy). This report summarizes the cases of the first 100 patients referred to the
Lyme Disease Center at Robert Wood Johnson Medical School.
In only 37 of the patients referred was
Lyme disease, either current or preceding, the explanation for the complaints. Many of the patients had another definable arthropathy. Twenty-five of the patients had fibromyalgia, which has not previously been reported in
Lyme disease. Three of these patients had active
Lyme disease at the time of evaluation, and 17 had a history suggesting preceding
Lyme disease. Approximately half of the 91 courses of antibiotic therapy given to these 100 patients before referral were probably unwarranted.
Anxiety about possible late manifestations of
Lyme disease has made
Lyme disease a "diagnosis of exclusion" in many endemic areas. Persistence of mild to moderate symptoms after adequate therapy and misdiagnosis of fibromyalgia and fatigue may incorrectly suggest persistence of infection, leading to further antibiotic therapy. Attention to patient anxiety and increased awareness of these musculoskeletal problems after therapy should decrease unnecessary therapy of previously treated