The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

The Long-Term Clinical Outcomes of Lyme Disease: A Population-Based Retrospective Cohort Study

Nancy A. Shadick, MD, MPOH; Charlotte B. Phillips, MPH; Eric L. Logigian, MD; Allen C. Steere, MD; Richard F. Kaplan, PhD; Victor P. Berardi, AB; Paul H. Duray, MD; Martin G. Larson, ScD; Elizabeth A. Wright, PhD; Katherine S. Ginsburg*, MD, MPH; Jeffrey N. Katz, MD, MS; and Matthew H. Liang, MD, MPH
[+] Article, Author, and Disclosure Information

Requests for Reprints: Nancy A. Shadick, MD, MPH, Department of Rheumatology-Immunology, PB2, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. Acknowledgments: The authors thank Catherine Lastavica, MD, for her epidemiologic and clinical advice; Richard Shadick, PhD, for his assistance with the neuropsychological training and testing; and Geoffrey Ginsburg, MD, for his clinical advice. Grant Support: In part by National Institutes for Health grants AR36308, AR20358, and AR07530. Dr. Shadick is supported by an Arthritis Foundation Postdoctoral Fellowship. Dr. Katz is supported by an Arthritis Foundation Investigator Award.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;121(8):560-567. doi:10.7326/0003-4819-121-8-199410150-00002
Text Size: A A A

Objective: To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.

Design: Population-based, retrospective cohort study.

Setting: A coastal region endemic for Lyme disease.

Participants: Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.

Measurements: A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.

Results: Compared with the control group (n = 43), the Lyme group (n = 38; mean duration from disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment (n = 4), and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).

Conclusions: Persons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.



lyme disease





Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.