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The Clinical Evolution of Lyme Arthritis

ALLEN C. STEERE, M.D.; ROBERT T. SCHOEN, M.D.; and ELISE TAYLOR, B.A.
[+] Article and Author Information

Grant support: in part by grants AM-20358, AM-07107, and RR-05443 from the United States Public Health Service and the Arthritis Foundation.

▸Requests for reprints should be addressed to Allen C. Steere, M.D.; New England Medical Center, Division of Rheumatology and Immunology, Box 406, 750 Washington Street; Boston, MA 02111.


New Haven, Connecticut


©1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;107(5):725-731. doi:10.7326/0003-4819-107-5-725
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To determine the clinical evolution of Lyme arthritis, 55 patients who did not receive antibiotic therapy for erythema chronicum migrans were followed longitudinally for a mean duration of 6 years. Of the 55 patients, 11 (20%) had no subsequent manifestations of Lyme disease. From 1 day to 8 weeks after disease onset, 10 of the patients (18%) began to have brief episodes of joint, periarticular, or musculoskeletal pain for as long as 6 years, but they never developed objective joint abnormalities. From 4 days to 2 years after disease onset, 28 (51%) had one episode or began to have intermittent attacks of frank arthritis, primarily in large joints; a few had polyarticular movement. The total number of these patients who continued to have recurrences decreased by 10% to 20% each year. The remaining 6 patients (11%) developed chronic synovitis later in the illness; of these, 2 (4%) had erosions, and 1 (2%), permanent joint disability. The spectrum of Lyme arthritis ranges from subjective joint pain, to intermittent attacks of arthritis, to chronic erosive disease.

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