ALLEN C. STEERE, M.D.; ALLAN GIBOFSKY, M.D.; MANUEL E. PATARROYO, M.D.; ROBERT J. WINCHESTER, M.D.; JOHN A. HARDIN, M.D.; STEPHEN E. MALAWISTA, M.D.
Ten patients with Lyme arthritis have developed chronic involvement of one or both knees. Lyme arthritis was diagnosed by onset with erythema chronicum migrans (six patients); residence in Lyme, Connecticut (eight); seasonal onset in summer and early fall (nine); early periods of short recurrent attacks (nine); absence of rheumatoid factor (nine); and absence of symmetrical polyarthritis, morning stiffness, subcutaneous nodules, or antinuclear antibodies (in all). Five patients had synovectomies; pannus formation and underlying cartilage erosion were present in all. Seven of the 10 patients had the same B-cell alloantigen, DRw2 (frequency in normal control subjects, 22%[ P< 0.005]), but did not have an increased frequency of the alloantigens associated with rheumatoid arthritis. Chronic Lyme arthritis, the result of an apparent tick-transmitted infection, resembles rheumatoid arthritis pathologically but generally differs from it in both prearticular and immunogenetic characteristics.
STEERE AC, GIBOFSKY A, PATARROYO ME, et al. Chronic Lyme Arthritis: Clinical and Immunogenetic Differentiation from Rheumatoid Arthritis. Ann Intern Med. 1979;90:896–901. doi: https://doi.org/10.7326/0003-4819-90-6-896
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Published: Ann Intern Med. 1979;90(6):896-901.
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