Serologische Diagnostik der Lyme-Arthritis

Abstract Sera from 19 patients with Lyme arthritis following erythema migrans and/or Bannwarth's syndrome, 100 patients with other inflammatory rheumatic diseases and 275 healthy controls were analysed to assess sensitivity and specificity of indirect IgM- and IgG-immunofluorescence tests (IFT, IFT-Abs = with absorption of sera with Treponema phagedenis) and IgG-ELISA for serodiagnosis of Lyme arthritis. Titers with the highest accuracy of aim were defined as cutoff levels: IFT ≥ 1 : 256, IFT-Abs ≥ 1 : 64, ELISA ≥ ; 13 U/ml (≥ 98 percentile for healthy individuals). IgM-antibodies against Borrelia burgdorferi were detected in only one of the sera from patients with Lyme arthritis provided that specificity was 99%. For determination of specific IgGantibodies all three methods were highly specific: IFT 98%, IFT-Abs 99%, and ELISA 97%. The highest diagnostic sensitivity, 94%, was obtained by the ELISA compared to 88% sensitivity in IFT and IFT-Abs; however, this difference seemed not to be significant. When sera from 185 patients with undifferentiated arthritis (and no history for Lyme borreliosis) were examined, in one case Lyme arthritis was proven by detection of rising titers of specific IgM antibodies and seroconversion, respectively. In 35 of the 185 sera specific IgG-antibodies indicating possible Lyme arthritis were detected; however, regarding eventual differential diagnoses in 12 of the 35 cases Lyme arthritis had to be queried. Serological investigations of 18 paired serum/synovial fluid samples did not reveal significant differences of specific antibody titers. By comparison of specific antibody titers with total IgG or albumin in synovial fluid and serum we found indices which altogether gave rise to the speculation of intraarticular antibody production but were not helpful in proving Lympe arthritis in individual cases.