Therapy for Lyme arthritis: Strategies for the treatment of antibiotic‐refractory arthritis

Steere, Allen C.; Angelis, Sheryn M.

doi:10.1002/art.22131

Cited by 213 publications

(253 citation statements)

References 48 publications

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“…(Dattwyler et al, 1988;Steere et al, 1994) In rare cases however, synovitis persists for months or even several years despite treatment with ≥2 months of oral antibiotics, ≥1 months of IV antibiotics, or usually both. (Steere and Angelis, 2006;Steere et al, 1994) Since PCR results for Bb DNA in joint fluid are almost always negative in the post-antibiotic period (Carlson et al, 1999;Nocton et al, 1994;Steere and Angelis, 2006) and since cellular and humoral immune responses to Bb antigens begin to decline soon after antibiotic treatment (Kannian et al, 2007a;Kannian et al, 2007b), antibiotic therapy appears to result in the nearly complete or total eradication of spirochetes from the joint, yet synovial inflammation still persists. This disease course, which has been termed antibiotic-refractory Lyme arthritis, is thought to be the result of an infection-induced autoimmune response.…”

Section: Introductionmentioning

confidence: 99%

Searching for borrelial T cell epitopes associated with antibiotic-refractory Lyme arthritis

Drouin

Glickstein

Kwok

et al. 2008

Molecular Immunology

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Antibiotic-refractory Lyme arthritis is believed to result from an infection-induced autoimmune response triggered by the spirochete Borrelia burgdorferi (Bb). Disease susceptibility is associated with the HLA alleles DRB1*0101, 0401, 0402, 0404, 0405 and DRB5*0101, and all these MHC molecules bind the Bb epitope OspA 163-175 . However, not all patients have a proliferative response to this epitope. To identify other possible Bb epitopes involved in this disease process, the algorithm TEPITOPE was used to scan 17 immunogenetic Bb proteins for potential T cell epitopes with a refractory arthritis-associated MHC binding profile, and the Bb proteome was searched for peptides with sequence homology to OspA [165][166][167][168][169][170][171][172][173] . Sixteen promising T epitopes were identified and their MHC binding profiles to 13 MHC molecules were verified using in vitro MHC/peptide binding assays. One peptide, BBK32 392-404 , had a strong refractory-arthritis associated MHC binding profile, and another GK 297-306 shared sequence homology to OspA [165][166][167][168][169][170][171][172][173] . However, patient cells did not proliferate in response to either peptide making it highly unlikely they were involved in a refractory course. A comparison of the in silico and in vitro results revealed that TEPITOPE correctly predicted 74% of the in vitro binding peptides, but it incorrectly predicted that 44% of the in vitrononbinding peptides would bind. For a particular MHC molecule, concordance between the in silico and in vitro results varied anywhere between 33% and 100%. Therefore, while additional Bb epitopes may be involved in the development of antibiotic-refractory Lyme arthritis, recognition of OspA [163][164][165][166][167][168][169][170][171][172][173][174][175] remains the only known Bb epitope associated with this disease.

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Section: Introductionmentioning

confidence: 99%

Searching for borrelial T cell epitopes associated with antibiotic-refractory Lyme arthritis

Drouin

Glickstein

Kwok

et al. 2008

Molecular Immunology

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“…11 The joint swelling and pain can spontaneously resolve within weeks to months. 13 For surveillance purposes, the CDC defines Lyme arthritis as recurrent, brief attacks over the course of weeks or months of objective monoarticular or oligoarticular joint swelling, or chronic monoarticular or polyarticular joint swelling. Cases of chronic progressive arthritis that are not preceded by brief attacks, chronic symmetrical polyarthritis, or arthralgia or myalgia alone are not sufficient to classify as musculoskeletal involvement of Lyme disease.…”

Section: Clinical Presentationmentioning

confidence: 99%

A Review of the Centers for Disease Control and Prevention’s Guidelines for the Clinical Laboratory Diagnosis of Lyme Disease

Miraglia

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this paper is to review information regarding the current guidelines for the clinical laboratory diagnosis of Lyme disease as set forth by the Centers for Disease Control and Prevention (CDC) to chiropractic physicians and to discuss the clinical utility of this testing. Methods: The CDC's website was reviewed to determine what their current recommendations are for the clinical laboratory testing of Lyme disease. Results: The CDC's established guidelines recommend the use of a 2-tiered serologic testing algorithm for the evaluation of patients with suspected Lyme disease. Conclusion: This review provides doctors of chiropractic with information to remain current with the CDC's recommended guidelines for Lyme disease testing because patients may present to their office with the associated signs and symptoms of Lyme disease. (J Chiropr Med 2016;15:272-280)

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“…If arthritis persists, a 2-4-week course of intravenous antibiotic therapy is recommended. If arthritis still persists and if the results of polymerase chain reaction testing for B burgdorferi DNA in joint fluid are negative, the patient is treated with antiinflammatory agents (11) …”

Section: To the Editormentioning

confidence: 99%

Therapy for Lyme arthritis: Strategies for the treatment of antibiotic‐refractory arthritis

Cited by 213 publications

References 48 publications

Searching for borrelial T cell epitopes associated with antibiotic-refractory Lyme arthritis

Searching for borrelial T cell epitopes associated with antibiotic-refractory Lyme arthritis

A Review of the Centers for Disease Control and Prevention’s Guidelines for the Clinical Laboratory Diagnosis of Lyme Disease

Reply to letter by Volkman commenting on the possible onset of seronegative disease in Lyme arthritis

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