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Deer tick bacteria DNA in joint fluid not reliable marker of active lyme arthritis
Date:5/16/2011

were searched for in a subgroup of these patients.

In most patients, erythema migrans skin lesions, an early disease manifestation, yielded positive culture and PCR results for the Lyme disease agent. Similarly, the majority of pre-treatment synovial fluid samples in patients with Lyme arthritis, a late disease manifestation, had positive PCR results for B. burgdorferi DNA. Patients with Lyme arthritis were treated with oral antibiotics for one or two months, and in those for whom the arthritis did not resolve, IV antibiotics were administered for an additional month. If they had persistent arthritis despite three months of antibiotics, patients were treated with non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).

About 30% of patients with persistent arthritis, despite the three month antibiotic regimen, still had positive PCR results for 4-9 months after the start of antibiotics. However, positive PCR results in the post-antibiotic period did not correlate with relapse or duration of arthritis. Moreover, synovial tissue samples obtained in the patients who underwent synovectomies for persistent arthritis more than one year after they first received antibiotics, in all cases, had uniformly negative culture and PCR results.

Researchers also detected B. burgdorferi mRNA, a marker of the bacterium viability, in 8 of 10 erythema migrans skin samples, but in none of 11 synovial fluid samples, including those taken prior to antibiotic treatment. Thus, the authors showed that the bacteria in erythema migrans samples were active and viable, while those in synovial fluid were near-dead or dead at any time point during the testing. "Our results confirm that detection of the bacteria which causes Lyme disease in synovial fluid is not a reliable test of active joint infection," Dr. Steere concluded. "We recommend treatment of patients with Lyme arthritis with appropriate oral and if necessary, IV antibi
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Contact: Dawn Peters
healthnews@wiley.com
781-388-8408
Wiley-Blackwell
Source:Eurekalert

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