WEDNESDAY, July 28, 2004 (HealthDayNews) -- Doctors order too many inappropriate tests for Lyme disease, often giving in to patients' demands, researchers report.
According to the new study, some 2.8 million tests for Lyme disease are given each year in the United States. All this testing costs the health-care system more than $100 million annually.
"We found that a good number of Lyme disease blood tests are ordered inappropriately, primarily for patients who come in without symptoms," said study author Dr. Alan H. Ramsey, an assistant clinical professor of family medicine from the University of Wisconsin.
But an advocate for people with Lyme disease disagreed, saying the test itself needs to be improved and people should take the test to, at the very least, put themselves at ease.
Lyme disease is an infection that results from being bitten by deer ticks that carry the Borrelia burgdorferi bacterium. Among its telltale signs are a bulls-eye rash at the bite site and stiffness in major joint such as knees and shoulders. The disease is treated with antibiotics.
In their study, the researchers looked at 356 blood tests for Lyme disease in Wisconsin. Of these, only 20 percent were classified as appropriate. At least 27 percent were inappropriate, and the rest were discretionary.
In more than 50 percent of the inappropriate tests, the patients didn't have symptoms of Lyme disease, according to the article in the July/August issue of the Annals of Family Medicine.
Moreover, 27 percent of the tests were done because the patients asked for them. Of these, almost 40 percent were inappropriate.
"There are many patients with nonspecific complaints asking for a test, worried that they have Lyme disease," Ramsey said. "It correlates these days with West Nile virus, with people coming in with nonspecific symptoms, worried that they have West Nile. If we can target those 27 percent of tests that are inappropriate and eliminate those, we are not going to miss any cases of Lyme disease."
To lower the number of inappropriate tests and reduce costs, patients and doctors need more education about Lyme disease, Ramsey said.
Testing should not be done to confirm that Lyme disease has been cured, Ramsey said. "That has no utility whatsoever," he added.
"Testing should be done based on symptoms," Ramsey added. Patients who have pain in some joints, inflammation of one of the facial nerves, meningitis, or who show signs of some heart problems such as an atrial ventricular block, should be tested for Lyme disease, he said.
Ramsey believes that people who have the typical bulls-eye rash associated with Lyme disease -- it is seen in almost 80 percent of cases -- do not need to be tested, but should be treated with antibiotics automatically. "If you are going to go ahead and treat the patient anyway, there is no utility in doing the test," he said.
"A tick bite doesn't mean that someone needs to have a Lyme disease test," Ramsey said. "Ordering or asking for a Lyme disease test without knowing what the signs and symptoms are is not a good approach."
"I am not at all surprised that only 20 percent of the serologic tests for Lyme disease that were ordered were considered appropriate," said Dr. Eugene D. Shapiro, a professor of pediatrics, epidemiology and investigative medicine from the Yale University School of Medicine.
Shapiro, who is a scientific advisor to the American Lyme Disease Foundation, believes that most of the tests that were classified as discretionary also were actually inappropriate. "There have been many other studies that have had similar findings," he added.
"Physicians frequently order such tests inappropriately as screening tests for patients with nonspecific, common complaints, such as fatigue or arthralgia [joint pain]," Shapiro said. "Positive tests in this setting are almost always falsely positive. There are bulletins from the FDA [U.S. Food and Drug Administration] that emphasize that tests for Lyme disease are not meant to be used as screening tests."
However, Karen Forschner, chairwoman of the board of directors of the Lyme Disease Foundation, worries that Lyme disease tests are not accurate and may miss many cases of the disease. She is also concerned that many people with Lyme disease go undiagnosed, and that limiting testing will add to that problem.
"Government and researchers would do better to develop a very good, sensitive test," she said. "The concern is not whether patients should be tested. The real concern is: What does the test mean, and why isn't the research community spending its time and effort developing an improved test?"
Forschner also said that patients should request tests if they are concerned. "They should have that discussion with their physician. It only makes sense," she said.
More information
The National Library of Medicine has plenty of information about Lyme disease.
