An in vitro assay was used to characterize the borreliacidal activity of sera from Lyme disease patients. The mean percentage of killing was 23% with sera from patients with a single erythema migrans lesion, 42% from patients with multiple lesions, 58% from patients with Lyme arthritis of short duration, and 83% from patients with Lyme arthritis of long duration. Borreliacidal activity was abrogated when Lyme disease serum was treated with anti-human IgM or IgG1. In addition, human sera from Lyme arthritis patients containing borreliacidal antibody prevented the induction of Lyme arthritis in irradiated hamsters challenged with the Lyme spirochete. Removal of outer surface protein A antibodies from late Lyme disease sera caused reductions in the borreliacidal antibody titer. The results demonstrate an important role for borreliacidal antibody against infection with B. burgdorferi in humans and confirm that detection of borreliacidal antibody in human sera can be a specific serodiagnostic test for Lyme disease.

Our results indicate that there is an urgent need for standardization of current testing methodologies. Until a national commitment is made, serological testing for Lyme disease will be of questionable value for the diagnosis of the disease.

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The ability of decreasing inocula of Borrelia burgdorferi to grow in otherwise identical Barbour-Stoenner-Kelly (BSK) media containing different lots of bovine serum albumin (fraction V) was determined. These media differed significantly in ability to detect B. burgdorferi. Some BSK media required inocula of 2 x I15 organisms per ml for detection, while other media could stimulate growth after inoculation with <2 organisms per ml. In addition, organisms from the less sensitive BSK media were thinner, longer, and less tightly coiled. The endpoint dilutions of indirect fluorescent-antibody titers, especially immunoglobulin M, exhibited up to 16-fold decreases, and both immunoglobulin G and M titers were more difficult to interpret with diagnostic slides prepared from some longer, thinner B. burgdorferi. These results demonstrate that, when performing laboratory investigations which rely on B. burgdorferi, it is essential that the quality of the BSK medium be determined.

SUMMARY Thirty-eight patients with rheumatoid arthritis in remission on penicillamine were entered into a prospective, randomised, placebo controlled study to determine the effects of gradual penicillamine withdrawal, to find a serological marker capable of predicting relapse, and to assess the effects of reintroduction of penicillamine. 80% of patients attempting gradual penicillamine withdrawal flared. There was no single serological marker capable of predicting outcome consistently. Decreasing SH levels were highly specific for recurrence of active synovitis but were insensitive. Reintroduction of penicillamine was successful. The implications of these findings, particularly concerning duration of therapy with disease modifying drugs, are discussed.The efficacy of D-penicillamine (penicillamine) in rheumatoid arthritis (RA) Many rheumatologists feel that, as the incidence of side effects such as thrombocytopenia6 and proteinuria7 is greater on higher doses of penicillamine, gradual reduction of the dose of the drug should be attempted. Anecdotal evidence suggests that on withdrawing penicillamine a recurrence of inflammatory activity is likely and that reintroduction of the drug is less successful.8 9There have been no published trials assessing the effects and risks of gradual penicillamine withdrawal. We therefore designed a prospective, randomised, placebo controlled study. Our objectives were to determine the effects of gradual withdrawal of penicillamine in patients with rheumatoid arthritis in remission, to find a serological marker that could predict relapse and therefore guide future withdrawal attempts, and thirdly to assess the results of the reintroduction of penicillamine.