Allen C. Steere, MD
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Steere AC. Duration of Antibiotic Therapy for Lyme Disease. Ann Intern Med. 2004;140:W-7. doi: 10.7326/0003-4819-140-4-200402170-00027-w2
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Published: Ann Intern Med. 2004;140(4):W-7.
Drs. Stricker and McNeil quote my editorial incorrectly. It is important to distinguish chronic Lyme arthritis, in which a knee remains inflamed for months or several years despite antibiotic therapy, from chronic post–Lyme disease syndrome or so-called chronic Lyme disease, in which patients develop musculoskeletal, neurocognitive, or fatigue symptoms (similar to chronic fatigue syndrome or fibromyalgia) during or soon after Lyme disease despite standard antibiotic treatment for Borrelia burgdorferi infection.
We have postulated that genetically susceptible patients with B. burgdorferi–infected knees may develop autoimmunity within the proinflammatory milieu of the joint because of molecular mimicry between an immunodominant epitope of outer-surface protein A and a host protein (1). A candidate molecular mimic was a sequence on the light chain of human lymphocyte function-associated antigen-1 (LFA-1 αL332-340), but we have come to think that this is not a relevant autoantigen in this disease (2). We have never postulated that autoimmunity or LFA-1 has any role in the pathogenesis of chronic post–Lyme disease syndrome.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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