John F. Bradley, BA; Russell C. Johnson, PhD; Jesse L. Goodman, MD
Bradley J., Johnson R., Goodman J.; The Persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis. Ann Intern Med. 1994;120:487-489. doi: 10.7326/0003-4819-120-6-199403150-00007
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Published: Ann Intern Med. 1994;120(6):487-489.
Lyme disease, caused by the spirochete Borrelia burgdorferi, is a common tick-borne infection. Arthritis develops in approximately one half of untreated patients who have a history of erythema migrans  and occurs, albeit rarely, even after treatment . Spirochetes have rarely been cultivated from synovial fluid [3, 4] but have been noted near blood vessels in silver-stained sections from synovectomy specimens . Because it is difficult to find spirochetes in affected joints, the host response [6-8] and specific class II immune response genes  have been suggested as major determinants in the pathogenesis of arthritis. The general failure to recover spirochetes, however, does not exclude a primary role for B. burgdorferi in initiating and maintaining the arthritic process. The polymerase chain reaction (PCR) is capable of detecting low numbers of organisms [10, 11]. Although we (unpublished data) and others  retrospectively detected B. burgdorferi DNA by PCR in stored synovial fluid, the extreme sensitivity of the PCR makes contamination of such samples and false-positive results a potential problem. Therefore, to test the hypothesis that noncultivatable B. burgdorferi persists in Lyme arthritis, we did controlled, prospective culture and PCR studies on synovial fluid from patients with Lyme arthritis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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