Robert T. Schoen, MD; M. Carrington Reid, PhD, MD
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Schoen R., Reid M.; Overdiagnosis of Lyme Disease. Ann Intern Med. 1998;129:752-753. doi: 10.7326/0003-4819-129-9-199811010-00032
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Published: Ann Intern Med. 1998;129(9):752-753.
Mr. Ferguson suggests that empirical antibiotic therapy may be more cost-effective for patients whose symptoms may or may not represent late-stage Lyme disease. Our results do not support this view. Although we were pleased to read that his symptoms improved after a brief course of tetracycline therapy, we do not know whether the institution of antibiotic therapy and resolution of symptoms are causally related.
Dr. Cherney raises several concerns about our study. Given our stated research objectives, she questions whether biased assessments of study patients could have occurred. Primary outcomes were abstracted from patients' medical records by investigators who had no knowledge of the patients' Yale Clinic diagnosis. Assigning a diagnosis of active, previous, or no evidence of Lyme disease, however, required that study physicians carefully review patients' records. We do not believe that this requirement led to misclassification of patients' diagnostic status or threatened the validity of our findings. The possibility of diagnostic misclassification was also raised for three patients who were given a diagnosis of previous but not active Lyme disease and who had peripheral neuropathies. We agree that the most difficult diagnostic challenges exist in such patients with new, persistent, or recurrent neurologic or arthritic symptoms.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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