Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Deer tick bacteria DNA in joint fluid not reliable marker of active lyme arthritis

17.05.2011
Patients with persistent arthritis require more intensive antibiotic and DMARD therapy

New research shows that polymerase chain reaction (PCR) testing for Borrelia burgdorferi DNA—the spirochetal bacteria transmitted by deer ticks—in joint fluid may confirm the diagnosis of Lyme arthritis, but is not a reliable indicator for active joint infection in patients whose arthritis persists after antibiotic therapy. Findings of this study are published in Arthritis & Rheumatism, a journal of the American College of Rheumatology (ACR).

Lyme disease is caused by the B. burgdorferi bacteria, which is transmitted to humans by the bite of an infected blacklegged tick, commonly known as the deer tick. The characteristic erythema migrans skin rash—resembling a bull's-eye mark—is often the first sign of infection, along with symptoms such as headache, fever, and fatigue. Surveillance data from the Centers for Disease Control and Prevention (CDC) report more than 30,000 new cases of Lyme disease each summer in the U.S., with 93% of cases occurring in Connecticut, Delaware, Massachusetts, Maryland, Minnesota, New Jersey, New York, Pennsylvania, Rhode Island, and Wisconsin. If left untreated, roughly 60% of patients will develop Lyme arthritis, which commonly affects the knee.

"Currently, the primary use for PCR testing in Lyme disease is to establish if active infection remains in patients with persistent arthritis following antibiotic therapy," said Allen Steere, M.D., Director of Clinical Research, Rheumatology Unit, at Massachusetts General Hospital and Harvard Medical School in Boston. "Our study goal was to determine the B. burgdorferi burden and viability in skin and joints of patients with Lyme disease." Researchers used PCR techniques to detect the deer tick bacteria DNA in skin samples of 90 patients with confirmed Lyme disease and in joint fluid or synovial tissue samples from 63 patients with Lyme arthritis, 23 who were responsive to antibiotics and 40 with antibiotic-refractory arthritis. In addition, both bacterial DNA and RNA were searched for in a subgroup of these patients.

In most patients, erythema migrans skin lesions, an early disease manifestation, yielded positive culture and PCR results for the Lyme disease agent. Similarly, the majority of pre-treatment synovial fluid samples in patients with Lyme arthritis, a late disease manifestation, had positive PCR results for B. burgdorferi DNA. Patients with Lyme arthritis were treated with oral antibiotics for one or two months, and in those for whom the arthritis did not resolve, IV antibiotics were administered for an additional month. If they had persistent arthritis despite three months of antibiotics, patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).

About 30% of patients with persistent arthritis, despite the three month antibiotic regimen, still had positive PCR results for 4-9 months after the start of antibiotics. However, positive PCR results in the post-antibiotic period did not correlate with relapse or duration of arthritis. Moreover, synovial tissue samples obtained in the patients who underwent synovectomies for persistent arthritis more than one year after they first received antibiotics, in all cases, had uniformly negative culture and PCR results.

Researchers also detected B. burgdorferi mRNA, a marker of the bacterium viability, in 8 of 10 erythema migrans skin samples, but in none of 11 synovial fluid samples, including those taken prior to antibiotic treatment. Thus, the authors showed that the bacteria in erythema migrans samples were active and viable, while those in synovial fluid were near-dead or dead at any time point during the testing. "Our results confirm that detection of the bacteria which causes Lyme disease in synovial fluid is not a reliable test of active joint infection," Dr. Steere concluded. "We recommend treatment of patients with Lyme arthritis with appropriate oral and if necessary, IV antibiotics for two to three months. However, in those with persistent arthritis despite oral and IV antibiotics of this duration, we then give DMARD treatment."

This study is published in Arthritis & Rheumatism. Media wishing to receive a PDF of the article may contact healthnews@wiley.com.

Full citation: "Burden and Viability of Borrelia burgdorferi in Skin or Joints of Patients with Erythema Migrans or Lyme Arthritis" Xin Li, Gail McHugh, Nitin Damle, Vijay K. Sikand, Lisa Glickstein, and Allen C. Steere. Arthritis & Rheumatism; Published Online: May 17, 2011 (DOI: 10.1002/art.30384).http://doi.wiley.com/10.1002/art.30384.

About the Journal

Arthritis & Rheumatism is an official journal of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP), a division of the College, and covers all aspects of inflammatory disease. The American College of Rheumatology (www.rheumatology.org) is the professional organization who share a dedication to healing, preventing disability, and curing the more than 100 types of arthritis and related disabling and sometimes fatal disorders of the joints, muscles, and bones. Members include practicing physicians, research scientists, nurses, physical and occupational therapists, psychologists, and social workers. For details, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1529-0131.

About Wiley-Blackwell

Wiley-Blackwell is the international scientific, technical, medical, and scholarly publishing business of John Wiley & Sons, with strengths in every major academic and professional field and partnerships with many of the world's leading societies. Wiley-Blackwell publishes nearly 1,500 peer-reviewed journals and 1,500+ new books annually in print and online, as well as databases, major reference works and laboratory protocols. For more information, please visit www.wileyblackwell.com or our new online platform, Wiley Online Library (wileyonlinelibrary.com), one of the world's most extensive multidisciplinary collections of online resources, covering life, health, social and physical sciences, and humanities.

Dawn Peters | EurekAlert!
Further information:
http://www.wiley.com

More articles from Life Sciences:

nachricht Toward a 'smart' patch that automatically delivers insulin when needed
18.01.2017 | American Chemical Society

nachricht 127 at one blow...
18.01.2017 | Stiftung Zoologisches Forschungsmuseum Alexander Koenig, Leibniz-Institut für Biodiversität der Tiere

All articles from Life Sciences >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

Im Focus: How to inflate a hardened concrete shell with a weight of 80 t

At TU Wien, an alternative for resource intensive formwork for the construction of concrete domes was developed. It is now used in a test dome for the Austrian Federal Railways Infrastructure (ÖBB Infrastruktur).

Concrete shells are efficient structures, but not very resource efficient. The formwork for the construction of concrete domes alone requires a high amount of...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

Nothing will happen without batteries making it happen!

05.01.2017 | Event News

 
Latest News

A big nano boost for solar cells

18.01.2017 | Power and Electrical Engineering

Glass's off-kilter harmonies

18.01.2017 | Materials Sciences

Toward a 'smart' patch that automatically delivers insulin when needed

18.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>