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 email@example.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.
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!
Biochemical 'fingerprints' reveal diabetes progression
22.08.2017 | Umea University
When fish swim in the holodeck
22.08.2017 | University of Vienna
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
22.08.2017 | Life Sciences
22.08.2017 | Life Sciences
22.08.2017 | Life Sciences