Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis
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. Using the French National Reference Center for Borrelia database, pati...
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creator | Grillon, Antoine Scherlinger, Marc Boyer, Pierre-Hugues De Martino, Sylvie Perdriger, Aleth Blasquez, Amandine Wipff, Julien Korganow, Anne-Sophie Bonnard, Christian Cantagrel, Alain Eyer, Didier Guérin, François Monteiro, Irène Woehl, Jean-Marie Moreau, Paul Pennaforte, Jean-Loup Lechevallier, Joel Bastides, Frédéric Colombey, Antoine Imbert, Isabelle Maugars, Yves Gicquel, Philippe Cuchet, François Brax, Michel Sibilia, Jean Zilliox, Laurence Barthel, Cathy Arnaud, Laurent Jaulhac, Benoit |
description | 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.
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.
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.
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. |
doi_str_mv | 10.1016/j.semarthrit.2018.09.007 |
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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.
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.
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.</description><identifier>ISSN: 0049-0172</identifier><identifier>EISSN: 1532-866X</identifier><identifier>DOI: 10.1016/j.semarthrit.2018.09.007</identifier><identifier>PMID: 30344080</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Anti-Bacterial Agents - therapeutic use ; Borrelia ; Borrelia - isolation & purification ; Child ; Female ; France ; Humans ; Life Sciences ; Lyme arthritis ; Lyme Disease - drug therapy ; Lyme Disease - microbiology ; Male ; Microbiology and Parasitology ; Middle Aged ; Polymerase Chain Reaction ; Rheumatic disease ; Synovial Fluid - microbiology ; Treatment Outcome ; Young Adult</subject><ispartof>Seminars in arthritis and rheumatism, 2019-06, Vol.48 (6), p.1105-1112</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><rights>Attribution - NonCommercial</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c458t-bc09731c24b988a98230ef870de40c91e34f4fe7ed3ae20ed098ccef28d37f2f3</citedby><cites>FETCH-LOGICAL-c458t-bc09731c24b988a98230ef870de40c91e34f4fe7ed3ae20ed098ccef28d37f2f3</cites><orcidid>0000-0002-5131-8524 ; 0000-0001-6877-6196 ; 0000-0002-1601-4795 ; 0000-0002-9453-5895</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0049017218304244$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30344080$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-02921189$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Grillon, Antoine</creatorcontrib><creatorcontrib>Scherlinger, Marc</creatorcontrib><creatorcontrib>Boyer, Pierre-Hugues</creatorcontrib><creatorcontrib>De Martino, Sylvie</creatorcontrib><creatorcontrib>Perdriger, Aleth</creatorcontrib><creatorcontrib>Blasquez, Amandine</creatorcontrib><creatorcontrib>Wipff, Julien</creatorcontrib><creatorcontrib>Korganow, Anne-Sophie</creatorcontrib><creatorcontrib>Bonnard, Christian</creatorcontrib><creatorcontrib>Cantagrel, Alain</creatorcontrib><creatorcontrib>Eyer, Didier</creatorcontrib><creatorcontrib>Guérin, François</creatorcontrib><creatorcontrib>Monteiro, Irène</creatorcontrib><creatorcontrib>Woehl, Jean-Marie</creatorcontrib><creatorcontrib>Moreau, Paul</creatorcontrib><creatorcontrib>Pennaforte, Jean-Loup</creatorcontrib><creatorcontrib>Lechevallier, Joel</creatorcontrib><creatorcontrib>Bastides, Frédéric</creatorcontrib><creatorcontrib>Colombey, Antoine</creatorcontrib><creatorcontrib>Imbert, Isabelle</creatorcontrib><creatorcontrib>Maugars, Yves</creatorcontrib><creatorcontrib>Gicquel, Philippe</creatorcontrib><creatorcontrib>Cuchet, François</creatorcontrib><creatorcontrib>Brax, Michel</creatorcontrib><creatorcontrib>Sibilia, Jean</creatorcontrib><creatorcontrib>Zilliox, Laurence</creatorcontrib><creatorcontrib>Barthel, Cathy</creatorcontrib><creatorcontrib>Arnaud, Laurent</creatorcontrib><creatorcontrib>Jaulhac, Benoit</creatorcontrib><title>Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis</title><title>Seminars in arthritis and rheumatism</title><addtitle>Semin Arthritis Rheum</addtitle><description>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.
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.
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.
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.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anti-Bacterial Agents - therapeutic use</subject><subject>Borrelia</subject><subject>Borrelia - isolation & purification</subject><subject>Child</subject><subject>Female</subject><subject>France</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Lyme arthritis</subject><subject>Lyme Disease - drug therapy</subject><subject>Lyme Disease - microbiology</subject><subject>Male</subject><subject>Microbiology and Parasitology</subject><subject>Middle Aged</subject><subject>Polymerase Chain Reaction</subject><subject>Rheumatic disease</subject><subject>Synovial Fluid - microbiology</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0049-0172</issn><issn>1532-866X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU1vEzEQhi0EoqHtX0A-wmGX8Ud37WOJKK0UCYRA4mY53rHiaHcdbCdS_z1OE8qxp5FePfOheQihDFoGrPu0bTNONpVNCqXlwFQLugXoX5EFuxG8UV33-zVZAEjdAOv5BXmX8xaAsQ76t-RCgJASFCxIWG5ssq5gCrkEl6mdB-rGMAdnRxr3xcUJa-orQUtCWyacC42eWjrbEuJcMRc3MT2F35c_ml3MoYQD0tXjhPR8ZchX5I23Y8brc70kv-6-_FzeN6tvXx-Wt6vGyRtVmrUD3QvmuFxrpaxWXAB61cOAEpxmKKSXHnschEUOOIBWzqHnahC9515cko-nuRs7ml0K9U-PJtpg7m9X5pgB15wxpQ-ssh9O7C7FP3vMxUwhOxxHO2PcZ8NZX1klWVdRdUJdijkn9M-zGZijFLM1_6WYoxQD2lQptfX9ect-PeHw3PjPQgU-nwCsfzkETCa7gLPDISR0xQwxvLzlLxWMpGw</recordid><startdate>201906</startdate><enddate>201906</enddate><creator>Grillon, Antoine</creator><creator>Scherlinger, Marc</creator><creator>Boyer, Pierre-Hugues</creator><creator>De Martino, Sylvie</creator><creator>Perdriger, Aleth</creator><creator>Blasquez, Amandine</creator><creator>Wipff, Julien</creator><creator>Korganow, Anne-Sophie</creator><creator>Bonnard, Christian</creator><creator>Cantagrel, Alain</creator><creator>Eyer, Didier</creator><creator>Guérin, François</creator><creator>Monteiro, Irène</creator><creator>Woehl, Jean-Marie</creator><creator>Moreau, Paul</creator><creator>Pennaforte, Jean-Loup</creator><creator>Lechevallier, Joel</creator><creator>Bastides, Frédéric</creator><creator>Colombey, Antoine</creator><creator>Imbert, Isabelle</creator><creator>Maugars, Yves</creator><creator>Gicquel, Philippe</creator><creator>Cuchet, François</creator><creator>Brax, Michel</creator><creator>Sibilia, Jean</creator><creator>Zilliox, Laurence</creator><creator>Barthel, Cathy</creator><creator>Arnaud, Laurent</creator><creator>Jaulhac, Benoit</creator><general>Elsevier Inc</general><general>WB Saunders</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0002-5131-8524</orcidid><orcidid>https://orcid.org/0000-0001-6877-6196</orcidid><orcidid>https://orcid.org/0000-0002-1601-4795</orcidid><orcidid>https://orcid.org/0000-0002-9453-5895</orcidid></search><sort><creationdate>201906</creationdate><title>Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis</title><author>Grillon, Antoine ; Scherlinger, Marc ; Boyer, Pierre-Hugues ; De Martino, Sylvie ; Perdriger, Aleth ; Blasquez, Amandine ; Wipff, Julien ; Korganow, Anne-Sophie ; Bonnard, Christian ; Cantagrel, Alain ; Eyer, Didier ; Guérin, François ; Monteiro, Irène ; Woehl, Jean-Marie ; Moreau, Paul ; Pennaforte, Jean-Loup ; Lechevallier, Joel ; Bastides, Frédéric ; Colombey, Antoine ; Imbert, Isabelle ; Maugars, Yves ; Gicquel, Philippe ; Cuchet, François ; Brax, Michel ; Sibilia, Jean ; Zilliox, Laurence ; Barthel, Cathy ; Arnaud, Laurent ; Jaulhac, Benoit</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c458t-bc09731c24b988a98230ef870de40c91e34f4fe7ed3ae20ed098ccef28d37f2f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anti-Bacterial Agents - therapeutic use</topic><topic>Borrelia</topic><topic>Borrelia - isolation & purification</topic><topic>Child</topic><topic>Female</topic><topic>France</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Lyme arthritis</topic><topic>Lyme Disease - drug therapy</topic><topic>Lyme Disease - microbiology</topic><topic>Male</topic><topic>Microbiology and Parasitology</topic><topic>Middle Aged</topic><topic>Polymerase Chain Reaction</topic><topic>Rheumatic disease</topic><topic>Synovial Fluid - microbiology</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grillon, Antoine</creatorcontrib><creatorcontrib>Scherlinger, Marc</creatorcontrib><creatorcontrib>Boyer, Pierre-Hugues</creatorcontrib><creatorcontrib>De Martino, Sylvie</creatorcontrib><creatorcontrib>Perdriger, Aleth</creatorcontrib><creatorcontrib>Blasquez, Amandine</creatorcontrib><creatorcontrib>Wipff, Julien</creatorcontrib><creatorcontrib>Korganow, Anne-Sophie</creatorcontrib><creatorcontrib>Bonnard, Christian</creatorcontrib><creatorcontrib>Cantagrel, Alain</creatorcontrib><creatorcontrib>Eyer, Didier</creatorcontrib><creatorcontrib>Guérin, François</creatorcontrib><creatorcontrib>Monteiro, Irène</creatorcontrib><creatorcontrib>Woehl, Jean-Marie</creatorcontrib><creatorcontrib>Moreau, Paul</creatorcontrib><creatorcontrib>Pennaforte, Jean-Loup</creatorcontrib><creatorcontrib>Lechevallier, Joel</creatorcontrib><creatorcontrib>Bastides, Frédéric</creatorcontrib><creatorcontrib>Colombey, Antoine</creatorcontrib><creatorcontrib>Imbert, Isabelle</creatorcontrib><creatorcontrib>Maugars, Yves</creatorcontrib><creatorcontrib>Gicquel, Philippe</creatorcontrib><creatorcontrib>Cuchet, François</creatorcontrib><creatorcontrib>Brax, Michel</creatorcontrib><creatorcontrib>Sibilia, Jean</creatorcontrib><creatorcontrib>Zilliox, Laurence</creatorcontrib><creatorcontrib>Barthel, Cathy</creatorcontrib><creatorcontrib>Arnaud, Laurent</creatorcontrib><creatorcontrib>Jaulhac, Benoit</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Seminars in arthritis and rheumatism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Grillon, Antoine</au><au>Scherlinger, Marc</au><au>Boyer, Pierre-Hugues</au><au>De Martino, Sylvie</au><au>Perdriger, Aleth</au><au>Blasquez, Amandine</au><au>Wipff, Julien</au><au>Korganow, Anne-Sophie</au><au>Bonnard, Christian</au><au>Cantagrel, Alain</au><au>Eyer, Didier</au><au>Guérin, François</au><au>Monteiro, Irène</au><au>Woehl, Jean-Marie</au><au>Moreau, Paul</au><au>Pennaforte, Jean-Loup</au><au>Lechevallier, Joel</au><au>Bastides, Frédéric</au><au>Colombey, Antoine</au><au>Imbert, Isabelle</au><au>Maugars, Yves</au><au>Gicquel, Philippe</au><au>Cuchet, François</au><au>Brax, Michel</au><au>Sibilia, Jean</au><au>Zilliox, Laurence</au><au>Barthel, Cathy</au><au>Arnaud, Laurent</au><au>Jaulhac, Benoit</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis</atitle><jtitle>Seminars in arthritis and rheumatism</jtitle><addtitle>Semin Arthritis Rheum</addtitle><date>2019-06</date><risdate>2019</risdate><volume>48</volume><issue>6</issue><spage>1105</spage><epage>1112</epage><pages>1105-1112</pages><issn>0049-0172</issn><eissn>1532-866X</eissn><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.
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.
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.
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.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30344080</pmid><doi>10.1016/j.semarthrit.2018.09.007</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-5131-8524</orcidid><orcidid>https://orcid.org/0000-0001-6877-6196</orcidid><orcidid>https://orcid.org/0000-0002-1601-4795</orcidid><orcidid>https://orcid.org/0000-0002-9453-5895</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Aged Anti-Bacterial Agents - therapeutic use Borrelia Borrelia - isolation & purification Child Female France Humans Life Sciences Lyme arthritis Lyme Disease - drug therapy Lyme Disease - microbiology Male Microbiology and Parasitology Middle Aged Polymerase Chain Reaction Rheumatic disease Synovial Fluid - microbiology Treatment Outcome Young Adult |
title | Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis |
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