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Lyme Disease Arthritis Can Be Slow to Respond to Antibiotics

Synovial inflammation can persist but even these 'non-responders' eventually respond to therapy

FRIDAY, Nov. 30 (HealthDay News) -- Some Lyme disease patients respond more slowly than others to antibiotic treatment for arthritis, but they do respond, suggesting that synovial inflammation persists in non-responsive patients after the period of infection, according to a report published online Nov. 29 in Arthritis & Rheumatism.

Priya Kannian, Ph.D., of Harvard Medical School in Boston, and colleagues followed 23 Lyme disease patients with antibiotic-responsive arthritis and 41 patients with antibiotic-refractory arthritis for whom at least three serial serum samples were obtained during the period of arthritis and sometime after several months of remission. Serial serum samples were also tested from 10 control patients from the 1970s who had not been treated with antibiotics.

In the antibiotic-responsive group, median antibody titers to most spirochetal antigens remained steady or decreased during the first three months of therapy, whereas during the same period median titers to most antigens increased slightly in the antibiotic-refractory group. However, by four to six months, reactivity to all antigens declined similarly in both groups. In the control group, antibody titers remained high throughout a two- to five-year period of arthritis.

The authors conclude that "patients with Lyme arthritis who have a sustained, gradual decline in antibody reactivity probably have nearly complete or total eradication of spirochetes from the joint as a result of antibiotic therapy, even if joint inflammation persists after the period of infection."

One of the study authors has received an honorarium from Novartis.

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