The Persistence of Spirochetal Nucleic Acids in Active Lyme Arthritis
Authors: John F. Bradley
Journal: Annals of Internal Medicine (1994)

Brief Reports15 March 1994The Persistence of Spirochetal Nucleic Acids in Active Lyme ArthritisJohn F. Bradley, BA, Russell C. Johnson, PhD, and Jesse L. Goodman, MDJohn F. Bradley, BASearch for more papers by this author, Russell C. Johnson, PhDSearch for more papers by this author, and Jesse L. Goodman, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-6-199403150-00007 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Lyme disease, caused by the spirochete Borrelia burgdorferi, is a common tick-borne infection. Arthritis develops in approximately one half of untreated patients who have a history of erythema migrans [1] and occurs, albeit rarely, even after treatment [2]. Spirochetes have rarely been cultivated from synovial fluid [3, 4] but have been noted near blood vessels in silver-stained sections from synovectomy specimens [5]. Because it is difficult to find spirochetes in affected joints, the host response [6-8] and specific class II immune response genes [9] have been suggested as major determinants in the pathogenesis of arthritis. The general failure to recover ...References1. Steere AC, Schoen RT, Taylor E. The clinical evolution of Lyme arthritis. Ann Intern Med. 1987; 107:725-31. Google Scholar2. Dattwyler RJ, Halperin JJ. Failure of tetracycline therapy in early Lyme disease. Arthritis Rheum. 1987; 30:448-50. Google Scholar3. Snydman DR, Schenkein DP, Berardi VP, Lastavica CC, Pariser KM. Borrelia burgdorferi in joint fluid in chronic Lyme arthritis. Ann Intern Med. 1986; 104:798-800. Google Scholar4. Schmidli J, Hunziker T, Moesli P, Schaad UB. Cultivation of Borrelia burgdorferi from joint fluid three months after treatment of facial palsy due to Lyme borreliosis (Letter). J Infect Dis. 1988; 158:905-6. Google Scholar5. Johnston YE, Duray PH, Steere AC, Kashgarian M, Buza J, Malawista SE, et al. Lyme arthritis. Spirochetes found in synovial microangiopathic lesions. Am J Pathol. 1985; 118:26-34. Google Scholar6. Beck G, Benach JL, Habicht GS. Isolation of interleukin 1 from joint fluids of patients with Lyme disease. J Rheumatol. 1989; 16:800-6. Google Scholar7. Steere AC, Brinckerhoff CE, Miller DJ, Drinker H, Harris ED Jr, Malawista SE. Elevated levels of collagenase and prostaglandin E2 from synovium associated with erosion of cartilage and bone in a patient with chronic Lyme arthritis. Arthritis Rheum. 1980; 23:591-9. Google Scholar8. Hardin JA, Steere AC, Malawista SE. Immune complexes and the evolution of Lyme arthritis. Dissemination and localization of abnormal C1q binding activity. N Engl J Med. 1979; 301:1358-63. Google Scholar9. Steere AC, Dwyer E, Winchester R. Association of chronic Lyme arthritis with HLA-DR4 and HLA-DR2 alleles. N Engl J Med. 1990; 323:219-23. Google Scholar10. Goodman JL, Jurkovich P, Kramber JM, Johnson RC. Molecular detection of persistent Borrelia burgdorferi in the urine of patients with active Lyme disease. Infect Immun. 1991; 59:269-78. Google Scholar11. Rys PN. PCR detection of Borrelia burgdorferi. In: Persing DH, ed. Diagnostic Molecular Microbiology: Principles and Applications. Washington, D.C.: American Society for Microbiology; 1993:203-10. Google Scholar12. Liebling MR, Nishio MJ, Rodriguez A, Sigel LH, Jin T, Louie JS. The polymerase chain reaction for the detection of Borrelia burgdorferi in human body fluids. Arthritis Rheum. 1993; 36:665-75. Google Scholar13. Barbour AG. Isolation and cultivation of Lyme disease spirochetes. Yale J Biol Med. 1984; 56:521-5. Google Scholar Author, Article, and Disclosure InformationAuthors: John F. Bradley, BA; Russell C. Johnson, PhD; Jesse L. Goodman, MDCorresponding Author: Dr. Jesse Goodman, Section of Infectious Diseases, University of Minnesota School of Medicine, Box 250 UMHC, 420 Delaware Street SE, Minneapolis, MN 55455.Acknowledgments: The authors thank Allan Ross for expert technical assistance, Drs. Judith Wanschura, Mike Rethwell, David Strike, Elizabeth Arndt, Tom Stillman, David Rhude, Kathleen Wesa, Archie Skemp, Walter Dorman, David Zoshke, Ellen Shammash, and Douglas Hotvedt for referring either patients or synovial fluid samples; Drs. Nicole Lurie and Nancy Meryhew for reviewing the manuscript; Beth Wetak and Jodi Aasmundrud for preparing the manuscript; and Dave Mottet for preparing the figure. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Polymerase Chain Reaction Assay for Borrelia burgdorferi in the Diagnosis of Lyme Disease Leonard H. Sigal Metrics Cited byLaboratory Diagnosis of Lyme BorreliosisClinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme DiseaseEfficacy of Double-Dose Dapsone Combination Therapy in the Treatment of Chronic Lyme Disease/Post-Treatment Lyme Disease Syndrome (PTLDS) and Associated Co-infections: A Report of Three Cases and Retrospective Chart ReviewA joint effort: The interplay between the innate and the adaptive immune system in Lyme arthritisSpecific composition of polyphenolic compounds with fatty acids as an approach in helping to reduce spirochete burden in Lyme disease: in vivo and human observational studyLyme Disease Outside InMapping the Lyme Disease ControversyPreventing LymeLiving LymeDiagnosing and Treating LymeLyme Disease, Evidence-Based Medicine, and the Biopolitics of TruthmakingThrough Lyme’s Looking GlassNotesReferencesChronic Lyme Disease: An Evidence-Based Definition by the ILADS Working GroupGenerality of Post-Antimicrobial Treatment Persistence of Borrelia burgdorferi Strains N40 and B31 in Genetically Susceptible and Resistant Mouse StrainsLyme Disease VaccinesProgress in the molecular diagnosis of Lyme diseaseControversies in Persistent (Chronic) Lyme DiseaseSyndromic Diagnostic Approaches to Bone and Joint infectionsAlternatives to Serologic Testing for Diagnosis of Lyme DiseaseBorreliaLyme disease: A rigorous review of diagnostic criteria and treatmentEvidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent diseaseLyme BorreliosisAutoimmunity in Lyme Arthritis: Molecular Mimicry between OspA and LFA-1Resurgence of Persisting Non-Cultivable Borrelia burgdorferi following Antibiotic Treatment in MiceOrchestration of Inflammation and Adaptive Immunity in Borrelia burgdorferi -Induced Arthritis by Neutrophil-Activating Protein ALyme disease vaccinesThe amber theory of Lyme arthritis: initial description and clinical implicationsBorrelia burgdorferi Persistence Post-antibiotic TreatmentBurden and viability of Borrelia burgdorferi in skin and joints of patients with erythema migrans or lyme arthritisThe Role of Culture and Nucleic Acid Amplification in Diagnosis of Lyme BorreliosisBorreliaIneffectiveness of Tigecycline against Persistent Borrelia burgdorferiReply to Stricker and JohnsonProspective Study of Serologic Tests for Lyme DiseaseLyme Arthritis: Pathogenesis, Clinical Presentation, and ManagementPersistence of Borrelia burgdorferi following Antibiotic Treatment in MiceLyme disease vaccinesLes traitements non antibiotiques de la borréliose de LymeLyme borreliosis in 2005, 30 years after initial observations in Lyme ConnecticutTherapy for Lyme arthritis: Strategies for the treatment of antibiotic-refractory arthritisThe Genus BorreliaChronic infection in ‘post-Lyme borreliosis syndrome’Diagnosis of Lyme BorreliosisClinical Characteristics and Treatment Outcome of Early Lyme Disease in Patients with Microbiologically Confirmed Erythema MigransRobert P. 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