Lyme Arthritis - Chronic Lyme

Of the problems my Chronic Lyme produces "Lyme Arthritis" is the least of my worries. Hobbling around like and old lady is nothing compared to loosing my mind. But every symptom of Lyme is important and what is most difficult to one person is the least of worries to another. An important 30 years study on Lyme arthritis was summarized today by none other than Alan Steere and he is not singing off the IDSA hymnal.

In a nut shell 124 people with Lyme studied over 30 years -43% had "antibiotic-refractory Lyme arthritis". Which means they are still producing Lyme antibodies even after the protocol dose of antibiotics either with or without evidence of the spirochete in their blood. For the lay person "antibiotic-refractory Lyme arthritis" means "I still have Lyme". 43% is a lot more than the 5% the IDSA has been preaching about.

See article below:

Original Source
http://www.medpagetoday.com/Rheumatology/GeneralRheumatology/14949


LITTLE FALLS, N.J., July 5 -- One strain of Borrelia burgdorferi appears to be more frequent in patients with antibiotic-refractory Lyme arthritis, researchers say. Action Points
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Explain that the RST1 strain of B. burgdorferi was associated with antibiotic-refractory arthritis in patients with Lyme disease.
The RST1 strain was most frequent in the joint fluid of patients with Lyme disease who didn't respond to antibiotics, Allen C. Steere, MD, of Massachusetts General Hospital, and colleagues reported in the July issue of Arthritis & Rheumatism.


"Our results add to the emerging literature concerning the differential pathogenicity of strains of B. burgdorferi," the researchers said.


The tick-borne spirochete causes Lyme disease, which often begins with erythema migrans, an expanding skin lesion. The spirochetes frequently disseminate within a week to the nervous system, heart, and joints, often promoting arthritis.


Two markers of B. burgdorferi -- OspC type and ribosomal RNA intergenic spacer type (RST) have been used to correlate strain variation with clinical outcomes, the researchers said.


OspC typing divides B. burgdorferi strains into 21 types, while the RST system divides them into just three groups, with certain RST groups corresponding uniquely to specific OspC types.


To identify the B. burgdorferi OspC and RST types in the joints of patients with Lyme arthritis, the researchers took joint fluid samples from 124 patients with Lyme disease over a 30-year period.


They analyzed them for OspC types by semi-nested polymerase chain reaction (PCR) and sequencing, and subsequently compared the findings with clinical information from the patients.


They identified OspC and RST genotypes in 40% of patients.


A total of 43% had OspC type K strains -- which correspond to RST2 variants -- and 22% had OspC type A strains -- which correspond with RST1.


The greater frequency of OspC type K strains than type A strains was statistically significant, the researchers said (P=0.05). This corresponds with finding OspC type K strains most frequently in erythema migrans lesions. OspC type A strains are more commonly isolated in blood.


Eight other OspC types and all three RSTs were identified in the remaining 35% of samples, the researchers said.


The researchers noted that the size of joint effusion tended to be larger and the total duration of arthritis was longer in the patients with RST1 or RST2 strains than in those infected with RST3 strains.


Also, the total duration of arthritis was significantly longer in those infected with RST1 strains than RST3 strains (P=0.05).


Among the 17 patients who had been treated with antibiotics, all seven infected with RST1 had antibiotic-refractory arthritis, compared with four of the six patients with RST2 and only one of four with RST3 (P=0.03).


It could be that the RST1 strains are more virulent and more inflammatory, the researchers said.


"RST1 strains seem to induce a more marked immune response, which may set the stage for joint inflammation that persists after antibiotic therapy in genetically susceptible individuals," they said.