Long-Term Outcomes of Persons with Lyme Disease
abstract & commentary
Synopsis: These data support clinicians who chose to advise their Lyme disease patients that adverse post-disease outcomes are the clear exception.
Source: Seltzer EG, et al. Long-term outcomes of persons with Lyme disease. JAMA 2000;283:609-616.
A variety of anecdotal reports suggest that Lyme disease may be associated with long-term sequelae of diverse nature. Connecticut, which requires all Lyme disease to be reported, was the setting for the evaluation of 672 persons identified as having Lyme disease, compared with a matched group of persons without the disease. Follow-up was up to 11 years in duration (mean 51 months), and mean patient age was 36.
Most people (71%) identified no long-term sequelae; 9% felt they were still not cured; and 20% were uncertain if they were cured. Persons who felt they were not cured were more likely to suffer impairments in activities of daily living in years following treated Lyme disease. However, the data comparing the control cohort to the post-Lyme disease group indicated that there were similar frequencies of complaints among controls as among Lyme disease subjects. Additionally, persons who met the most stringent criteria for confirmed Lyme disease actually had a lower frequency of difficulties with daily activities than those whose fulfillment of diagnostic criteria was less complete, a percentage of whom must surely have been incorrectly diagnosed as having Lyme disease.
There were rare instances of Lyme disease sufferers who experienced significant complications such as (recurrent) arthritis in persons who did not receive prompt treatment and are genetically disposed to autoimmune-mediated arthritis. On the other hand, these data support clinicians who chose to advise their Lyme disease patients that adverse post-disease outcomes are the clear exception. (Dr. Kuritzky is Clinical Assistant Professor, University of Florida, Gainesville, FL.)
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