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Musculoskeletal and Neurologic Outcomes in Patients with Previously Treated Lyme Disease

Nancy A. Shadick, MD, MPH; Charlotte B. Phillips, MPH; Oliver Sangha, MD, MPH; Eric L. Logigian, MD; Richard F. Kaplan, PhD; Elizabeth A. Wright, PhD; Anne H. Fossel; Karin Fossel, MA; Victor Berardi, BA; Robert A. Lew, PhD; and Matthew H. Liang, MD, MPH
[+] Article and Author Information

From Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts; University of Rochester School of Medicine and Dentistry, Rochester, New York; Bavarian Public Health Research Center Ludwig, Maximilians University Munich School of Medicine, Munich, Germany; University of Connecticut Health Center, Farmington, Connecticut; and IMUGEN, Inc., Norwood, Massachusetts.


Acknowledgments: The authors thank Drs. Allen Steere and Jeffrey Katz for reviewing the manuscript, Ms. Mary Scamman for her help with manuscript preparation, and Ms. Cheryl Bartlett and the staff of the Nantucket Cottage Hospital for support and resources. They also thank the residents of Nantucket Island for their enthusiasm and their participation in the study.

Grant Support: In part by National Institutes of Health grant AR36308. Dr. Shadick is supported by an Arthritis Investigator Award from the Arthritis Foundation and by a National Institutes of Health Mentored Clinical Science Research Award (02033).

Requests for Reprints: Nancy A. Shadick, MD, MPH, Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. Shadick: Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Ms. Phillips, Dr. Wright, Ms. A. Fossel, Ms. K. Fossel, and Dr. Lew: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.

Dr. Sangha: Bavarian Public Health Research Center Ludwig, Maximilians University Munich School of Medicine, Munich D-81549, Germany.

Dr. Logigian: University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642.

Dr. Kaplan: University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030.

Mr. Berardi: IMUGEN, Inc., 220 Norwood Park South, Norwood, MA 02364.

Dr. Liang: R.B. Brigham Arthritis Center, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.


Ann Intern Med. 1999;131(12):919-926. doi:10.7326/0003-4819-131-12-199912210-00003
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Lyme disease is a multisystem disorder of the skin, nervous system, heart, and joints (13) caused by tick-borne infection with Borrelia burgdorferi. Although the neurologic and musculoskeletal sequelae of Lyme disease are well described (410), their long-term clinical and functional effects in patients previously treated with antibiotics are not well understood. Several follow-up analyses demonstrated an increased prevalence of neurocognitive and musculoskeletal sequelae in persons with previous Lyme disease (47, 11), particularly those who had the infection for a longer period before receiving treatment (5, 11).

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Figure 1.
Sampling strategy and study design used to determine case status and measure clinical and functional outcomes in participants with and those without previous Lyme disease.Borrelia burgdorferi

Potential case-patients included those who reported a previous diagnosis of Lyme disease or a previous positive result on a serologic test for (group I). Potential controls included all persons who responded that they had no history of Lyme disease. Balance among controls was achieved by choosing one respondent with symptoms suggestive of possible acute Lyme disease (such as history of Bell palsy; swollen joints; persistent cognitive difficulties; or a large, red, ringlike, expanding rash) (group II) for each respondent who had no symptoms suggestive of possible Lyme disease (group III). CDC = Centers for Disease Control and Prevention. *Adult = person 17 years of age or older.

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Summary for Patients

Health Outcomes of Patients Previously Treated for Lyme Disease

The summary below is from the full report titled “Musculoskeletal and Neurologic Outcomes in Patients with Previously Treated Lyme Disease.” It is in the 12 December 1999 issue of Annals of Internal Medicine (volume 131, pages 919-926). The authors are N.A. Shadick, C.B. Phillips, O. Sangha, E.L. Logigian, R.F. Kaplan, E.A. Wright, A.H. Fossel, K. Fossel, V. Berardi, R.A. Lew, and M.H. Liang.

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