title: Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease.
abstract: 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.
authors.affiliation: Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Shadick
authors.forename: C B
authors.initials: CB
authors.lastname: Phillips
authors.forename: O
authors.initials: O
authors.lastname: Sangha
authors.forename: E L
authors.initials: EL
authors.lastname: Logigian
authors.forename: R F
authors.initials: RF
authors.lastname: Kaplan
authors.forename: E A
authors.initials: EA
authors.lastname: Wright
authors.forename: A H
authors.initials: AH
authors.lastname: Fossel
authors.forename: K
authors.initials: K
authors.lastname: Fossel
authors.forename: V
authors.initials: V
authors.lastname: Berardi
authors.forename: R A
authors.initials: RA
authors.lastname: Lew
authors.forename: M H
authors.initials: MH
authors.lastname: Liang
mesh_terms: 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