Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease.
BACKGROUND
Previous follow-up studies of patients with Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity.


OBJECTIVE
To determine clinical and functional outcomes in persons who were treated for Lyme disease in the late 1980s.


METHODS
Population-based, retrospective cohort study.


METHODS
Nantucket Island, Massachusetts.


METHODS
186 persons who had a history of Lyme disease (case-patients) and 167 persons who did not (controls).


METHODS
Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-item Short Form Health Survey [SF-36]), mood state assessment (Profile of Mood States), neurocognitive tests, and serologic examination.


RESULTS
The prevalence of Lyme disease among adults on Nantucket Island was estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous Lyme disease (mean time from infection to study evaluation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impairment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0.003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P < 0.001) than persons without previous Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the performance of the two groups on neurocognitive tests did not significantly differ.


CONCLUSIONS
Because persons with previous Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.
Shadick
N A
NA
Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Phillips
C B
CB
Sangha
O
O
Logigian
E L
EL
Kaplan
R F
RF
Wright
E A
EA
Fossel
A H
AH
Fossel
K
K
Berardi
V
V
Lew
R A
RA
Liang
M H
MH
D000328:Adult; D018771:Arthralgia / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008193:Lyme Disease / Q000145:classification / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009140:Musculoskeletal Diseases / Q000209:etiology*; D009422:Nervous System Diseases / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012189:Retrospective Studies