1. Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis
- Author
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Marc Scherlinger, Didier Eyer, Aleth Perdriger, Amandine Blasquez, Frédéric Bastides, Laurence Zilliox, François Guérin, Jean-Marie Woehl, Antoine Grillon, Yves Maugars, Pierre-Hugues Boyer, Alain Cantagrel, Antoine Colombey, Paul Moreau, Jean Sibilia, François Cuchet, Anne-Sophie Korganow, Christian Bonnard, Julien Wipff, Joel Lechevallier, Isabelle Imbert, Irène Monteiro, Jean-Loup Pennaforte, Laurent Arnaud, Philippe Gicquel, Michel Brax, Benoît Jaulhac, Sylvie De Martino, Cathy Barthel, Virulence bactérienne précoce : fonctions cellulaires et contrôle de l'infection aiguë et subaiguë, Université de Strasbourg (UNISTRA), Virulence Bactérienne Précoce : fonctions cellulaires et contrôle de l'infection aigüe et subaigüe, Immuno-Rhumatologie Moléculaire, and Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Arthritis ,Lyme Arthritis ,Polymerase Chain Reaction ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Rheumatology ,Internal medicine ,Borrelia ,Synovitis ,Synovial Fluid ,Medicine ,Synovial fluid ,Humans ,030212 general & internal medicine ,Child ,Aged ,030203 arthritis & rheumatology ,Doxycycline ,Lyme Disease ,biology ,business.industry ,Amoxicillin ,Middle Aged ,biology.organism_classification ,medicine.disease ,bacterial infections and mycoses ,Sciences du Vivant [q-bio]/Microbiologie et Parasitologie ,3. Good health ,Anti-Bacterial Agents ,Anesthesiology and Pain Medicine ,Treatment Outcome ,[SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology ,Polyarthritis ,Female ,France ,business ,medicine.drug - Abstract
To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available. Objectives To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available. Methods Using the French National Reference Center for Borrelia database, patients with a positive PCR on synovial fluid for Borrelia were identified. Patient clinical and biological characteristics were reviewed from patient records. Long-term outcomes after treatment were studied through a questionnaire and with follow-up data. Results Among 357 synovial fluid testing by PCR between 2010 and 2016, 37 (10.4%) were positive for Borrelia. Patients’ median age was 36 years (range 6–78) with 61% of men and 28% patients under 18. The presentation was monoarticular in 92% and the knee was involved in 97%. Contrary to the Borrelia species repartition in European ticks, B. burgdorferi sensu stricto was the most prevalent species found in synovial fluid (54%) followed by B. azfelii (29%) and B. garinii (17%). Antibiotic treatments were mainly composed of doxycycline (n = 24), ceftriaxone (n = 10) and amoxicillin (n = 6), for a median duration of 4 weeks (range 3–12). Despite a properly conducted treatment, 34% of patients (n = 12) developed persistent synovitis for at least 2 months (median duration 3 months, range 2–16). Among those, 3 developed systemic inflammatory oligo- or polyarthritis in previously unaffected joints with no signs of persistent infection (repeated PCR testing negative), which mandated Disease-Modifying Antirheumatic Drugs (DMARD) introduction, leading to remission. Conclusion In France and contrary to ticks ecology, Lyme arthritis is mainly caused by B. burgdorferi sensu stricto. Despite proper antibiotic therapy, roughly one third of patients may present persistent inflammatory synovitis and a small proportion may develop systemic arthritis. In such cases, complete remission can be reached using DMARD. journal article 2019 06 2018 09 28 imported
- Published
- 2019