title: Differential diagnoses of suspected Lyme borreliosis or post-Lyme-disease syndrome.
abstract: The symptoms of Lyme borreliosis are similar to those of a variety of autoimmune musculoskeletal diseases. Persistence of complaints is frequently interpreted as unsuccessful antibiotic treatment of Borrelia-associated infections. However, such refractory cases are rare, and re-evaluation of differential diagnoses helps to avoid the substantial risk of long-term antibiotic therapy. In this study, we analyzed patients who presented to our rheumatology unit with previous suspected or diagnosed Lyme borreliosis. Eighty-six patients from a 3.5-year period were evaluated. The mean age of patients was 49.2 +/- 17.2 years; 60% (n = 52) reported a tick bite and 33% (n = 28) an erythema. Forty-seven percent (n = 39) had positive enzyme-linked immunoassay results and Western blots (Mikrogen, Martinsried, Germany). All but 12 patients had already received antibiotic treatment previously. Nine percent (n = 8) had ongoing or recent Lyme borreliosis. Twenty-nine percent (n = 25) showed clinical symptoms and radiographic changes compatible with degenerative disorders of the cervical and/or lumbar spine. These patients were significantly older when compared to the other patients (59.3 +/- 13.7 years vs 46.1 +/- 17.2 years, p = 0.001). Seventeen percent (n = 16) had arthropathies related to psoriasis or rheumatoid arthritis. Twelve percent (n = 10) were positive for the HLA B27 antigen. Other diseases were less frequent. Six patients (7%) could not be diagnosed conclusively, and four of these patients had negative Borrelia immunoassay results. In conclusion, Borrelia-associated diseases were rare in this study. Differential diagnoses helped to initiate a successful disease-specific therapeutic strategy.
authors.affiliation: Medical University Policlinic, Rheumatology Unit Wilhelmstr, Bonn, Germany. Matthias.Seidel@ukb.uni-bonn.de
authors.forename: M F
authors.initials: MF
authors.lastname: Seidel
authors.forename: A Belda
authors.initials: AB
authors.lastname: Domene
authors.forename: H
authors.initials: H
authors.lastname: Vetter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000907:Antibodies, Bacterial / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000473:pathology; D015153:Blotting, Western; D001898:Borrelia / Q000276:immunology*; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D015796:HLA-B27 Antigen / Q000032:analysis; D006801:Humans; D008193:Lyme Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000175:diagnosis / Q000473:pathology; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D015796:HLA-B27 Antigen