title: Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane, but not in synovial fluid from patients with persisting Lyme arthritis after antibiotic therapy.
abstract: OBJECTIVE
  To identify possible sites of bacterial persistence in patients with treatment resistant Lyme arthritis. It was determined whether Borrelia burgdorferi DNA may be detectable by polymerase chain reaction (PCR) in synovial membrane (SM) when PCR results from synovial fluid (SF) had become negative after antibiotic therapy.
  
  
  METHODS
  Paired SF and SM specimens and urine samples from four patients with ongoing or recurring Lyme arthritis despite previous antibiotic therapy were investigated. A PCR for the detection of B burgdorferi DNA was carried out using primer sets specific for the ospA gene and a p66 gene of B burgdorferi.
  
  
  RESULTS
  In all four cases, PCR with either primer set was negative in SF and urine, but was positive with at least one primer pair in the SM specimens. In all patients arthritis completely resolved after additional antibiotic treatment.
  
  
  CONCLUSIONS
  These data suggest that in patients with treatment resistant Lyme arthritis negative PCR results in SF after antibiotic therapy do not rule out the intraarticular persistence of B burgdorferi DNA. Therefore, in these patients both SF and SM should be analysed for borrelial DNA by PCR as positive results in SM are strongly suggestive of ongoing infection.
authors.affiliation: Charité University Hospital, Department of Medicine III, Rheumatology and Clinical Immunology, Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Priem
authors.forename: G R
authors.initials: GR
authors.lastname: Burmester
authors.forename: T
authors.initials: T
authors.lastname: Kamradt
authors.forename: K
authors.initials: K
authors.lastname: Wolbart
authors.forename: M G
authors.initials: MG
authors.lastname: Rittig
authors.forename: A
authors.initials: A
authors.lastname: Krause
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015748:Borrelia burgdorferi Group / Q000302:isolation & purification*; D004269:DNA, Bacterial / Q000032:analysis; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D013582:Synovial Fluid / Q000382:microbiology; D013583:Synovial Membrane / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial