title: Chronic Lyme arthritis. Clinical and immunogenetic differentiation from rheumatoid arthritis.
abstract: Ten patients with Lyme arthritis have developed chronic involvement of one or both knees. Lyme arthritis was diagnosed by onset with erythema chronicum migrans (six patients); residence in Lyme, Connecticut (eight); seasonal onset in summer and early fall (nine); early periods of short recurrent attacks (nine); absence of rheumatoid factor (nine); and absence of symmetrical polyarthritis, morning stiffness, subcutaneous nodules, or antinuclear antibodies (in all). Five patients had synovectomies; pannus formation and underlying cartilage erosion were present in all. Seven of the 10 patients had the same B-cell alloantigen, DRw2 (frequency in normal control subjects, 22% [P less than 0.005]), but did not have an increased frequency of the alloantigens associated with rheumatoid arthritis. Chronic Lyme arthritis, the result of an apparent tick-transmitted infection, resembles rheumatoid arthritis pathologically but generally differs from it in both prearticular and immunogenetic characteristics.
mesh_terms: D000293:Adolescent; D000328:Adult; D001168:Arthritis / Q000175:diagnosis*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis*; D001402:B-Lymphocytes / Q000276:immunology; D002648:Child; D002908:Chronic Disease; D003237:Connecticut; D003937:Diagnosis, Differential; D004890:Erythema / Q000175:diagnosis; D005260:Female; D006801:Humans; D007519:Isoantigens / Q000302:isolation & purification; D007719:Knee Joint / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012217:Rheumatoid Factor / Q000302:isolation & purification; D012621:Seasons
chemical_list: D007519:Isoantigens; D012217:Rheumatoid Factor