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Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis
- Source :
- Seminars in Arthritis and Rheumatism, Seminars in Arthritis and Rheumatism, WB Saunders, 2019, 48 (6), ⟨10.1016/j.semarthrit.2018.09.007⟩
- Publication Year :
- 2019
- Publisher :
- HAL CCSD, 2019.
-
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
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 00490172
- Database :
- OpenAIRE
- Journal :
- Seminars in Arthritis and Rheumatism, Seminars in Arthritis and Rheumatism, WB Saunders, 2019, 48 (6), ⟨10.1016/j.semarthrit.2018.09.007⟩
- Accession number :
- edsair.doi.dedup.....4bf47f4fe0902214251e21042e1f174d