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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Veröffentlicht in:Seminars in arthritis and rheumatism 2019-06, Vol.48 (6), p.1105-1112
Hauptverfasser: 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
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container_end_page 1112
container_issue 6
container_start_page 1105
container_title Seminars in arthritis and rheumatism
container_volume 48
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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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. 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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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identifier ISSN: 0049-0172
ispartof Seminars in arthritis and rheumatism, 2019-06, Vol.48 (6), p.1105-1112
issn 0049-0172
1532-866X
language eng
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source MEDLINE; Elsevier ScienceDirect Journals
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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