Rheumatic manifestations in Lyme borreliosis

Lyme arthritis was first described by Steere et al in 1976 as a previously unrecognized rheumatic disorder. 1 The primary credit for this goes to two concerned mothers from Old Lyme, Connecticut. They had called the attention of the state health department and the Yale Rheumatology Clinic to an unusual geographic clustering of individuals, mostly children, with arthritis in their small community. In most of the affected children the diagnosis of juvenile rheumatoid arthritis had been made. 2 Further studies of this epidemic form of arthritis then revealed that Lyme arthritis was only one expression of a complex multisystem disorder, thereafter called Lyme disease, that may also affect the skin, heart, and nervous system. 2,3 The cutaneous marker and the neurologic manifestations of Lyme disease were found to be consistent with entities well known in Europe since the early 1900s, erythema migrans 4 and lymphocytic meningopolyneuritis; 5,6 however, joint symptoms had hitherto only casually been mentioned in case reports on erythema migrans 7,8 and lymphocytic meningopolyneuritis. 6,9,10 Thus, it was for a long time thought that Lyme disease in North America differs from the corresponding European syndrome in the frequency and severity of arthritic manifestations. Following the description of Lyme arthritis in North America the first case reports on the association of erythema migrans and arthritis in Europe were published in 1980. 11,12 In the meantime, it is to be supposed that the presumed continental difference as regards arthritis merely reflected the lack of awareness of Lyme arthritis in Europe and that the rheumatologic spectrum of the disease is quite similar on both sides of the Atlantic. 13 With respect to historical notes on rheumatologic aspects of Lyme borreliosis, the earlier literature on aerodermatitis chronica atrophicans (ACA), now known to be caused by a chronic skin infection with Borrelia burgdorferi, 14,15 is of particular interest. First, because of the predilection of the skin lesions for extensor sites over the joints, the term arthrodermatitis was considered more appropriate. 16 Second, joint and bone abnormalities in association with ACA were described by several European authors 17–25 and also in a case report from North America. 26 This even led to proposal of the designation acrodermatitis chronica arthropathica. 22 Finally, it is noteworthy that histologic findings of myositis were noted in two case reports on ACA. 22,24