Musculoskeletal and Neurologic Outcomes in Patients with Previously Treated Lyme Disease

21 December 1999 | Volume 131 Issue 12 | Pages 919-926

Background: Previous follow-up studies of patients with Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity.

Objective: To determine clinical and functional outcomes in persons who were treated for Lyme disease in the late 1980s.

Design: Population-based, retrospective cohort study.

Setting: Nantucket Island, Massachusetts.

Participants: 186 persons who had a history of Lyme disease (case-patients) and 167 persons who did not (controls).

Measurements: Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), mood state assessment (Profile of Mood States), neurocognitive tests, and serologic examination.

Results: The prevalence of Lyme disease among adults on Nantucket Island was estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous Lyme disease (mean time from infection to study evaluation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impairment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0.003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P < 0.001) than persons without previous Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the performance of the two groups on neurocognitive tests did not significantly differ.

Conclusions: Because persons with previous Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.

Author and Article Information

From Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; University of Rochester School of Medicine and Dentistry, Rochester, New York; Bavarian Public Health Research Center Ludwig, Maximilians University Munich School of Medicine, Munich, Germany; University of Connecticut Health Center, Farmington, Connecticut; and IMUGEN, Inc., Norwood, Massachusetts.

Acknowledgments: The authors thank Drs. Allen Steere and Jeffrey Katz for reviewing the manuscript, Ms. Mary Scamman for her help with manuscript preparation, and Ms. Cheryl Bartlett and the staff of the Nantucket Cottage Hospital for support and resources. They also thank the residents of Nantucket Island for their enthusiasm and their participation in the study.

Grant Support: In part by National Institutes of Health grant AR36308. Dr. Shadick is supported by an Arthritis Investigator Award from the Arthritis Foundation and by a National Institutes of Health Mentored Clinical Science Research Award (02033).

Requests for Reprints: Nancy A. Shadick, MD, MPH, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

Current Author Addresses: Dr. Shadick: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Ms. Phillips, Dr. Wright, Ms. A. Fossel, Ms. K. Fossel, and Dr. Lew: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Sangha: Bavarian Public Health Research Center Ludwig, Maximilians University Munich School of Medicine, Munich D-81549, Germany.

Dr. Logigian: University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.

Dr. Kaplan: University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Mr. Berardi: IMUGEN, Inc., 220 Norwood Park South, Norwood, MA 02364.

Dr. Liang: R.B. Brigham Arthritis Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.