title: The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study.
abstract: OBJECTIVE
  To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.
  
  
  METHODS
  Population-based, retrospective cohort study.
  
  
  METHODS
  A coastal region endemic for Lyme disease.
  
  
  METHODS
  Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.
  
  
  METHODS
  A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.
  
  
  RESULTS
  Compared with the control group (n = 43), the Lyme group (n = 38; mean duration from disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment [n = 4], and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).
  
  
  CONCLUSIONS
  Persons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.
authors.affiliation: Department of Rheumatology-Immunology, Brigham & Women's Hospital, Boston, MA 02115.
authors.forename: N A
authors.initials: NA
authors.lastname: Shadick
authors.forename: C B
authors.initials: CB
authors.lastname: Phillips
authors.forename: E L
authors.initials: EL
authors.lastname: Logigian
authors.forename: A C
authors.initials: AC
authors.lastname: Steere
authors.forename: R F
authors.initials: RF
authors.lastname: Kaplan
authors.forename: V P
authors.initials: VP
authors.lastname: Berardi
authors.forename: P H
authors.initials: PH
authors.lastname: Duray
authors.forename: M G
authors.initials: MG
authors.lastname: Larson
authors.forename: E A
authors.initials: EA
authors.lastname: Wright
authors.forename: K S
authors.initials: KS
authors.lastname: Ginsburg
authors.forename: J N
authors.initials: JN
authors.lastname: Katz
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
mesh_terms: D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008193:Lyme Disease / Q000097:blood / Q000150:complications* / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000209:etiology*; D009422:Nervous System Diseases / Q000209:etiology*; D010808:Physical Examination; D011594:Psychometrics; D012189:Retrospective Studies; D012307:Risk Factors; D016622:Silver Staining; D011795:Surveys and Questionnaires; D013997:Time Factors