Lyme arthritis appearing outside the United States: a case report from Switzerland.
Authors: J C Gerster, S Guggi, H Perroud, R Bovet
Journal: BMJ (1981)

Anti-inflammatory drugs in management of spondylosisIn 1976 we drew attention to the uncertain rationale in the use of anti-inflammatory drugs in the management of osteoarthritis.'We pointed out that osteoarthrosis is not an inflammatory process per primum, though focal inflammatory changes may occur from time to time in any given joint probably brought about by the products of cartilage degradation.Despite this information, available in stan- dard orthopaedic texts, anti-inflammatory drugs are widely ad- ministered to patients with osteoarthrosis at considerable cost and to no clear benefit.Indeed, indomethacin has been indicted on more than one occasion for accelerated deterioration of the hip joint in osteoarthrosis.2 ) This is probably attributable to the known in- hibitory effect of this drug on cartilage' and bone metabolism., We consider that the published findings represent only the tip of the iceberg. Methods and resultsThe dearth of information and the unbelievable paucity of controlled clinical trials for the usc of anti-inflammatory drugs in spondylosis prompted us to carry out a double-blind cross-over trial using indomethacin, flurbiprofen, and placebo in the trcatment of symptomatic lumbar spondvlosis in adults.Such a trial has not been reported previously.Twenty-four patients were studied; all had chronic symptoms of back pain, leg pain, or both attributable to this disorder, but none were in an acute episode at the time of the trial.Patients received each of the drugs or placebo for two weeks, and the sequcnce of administration was planned to minimise carry-over effects.Indomethacin was administered at 150 mg daily and flurbiprofen at 300 mg daily.Eleven of the 24 patients in the trial showed no measurable response to the drugs used.Overall, flurbiprofen was found to be statistically no more effective than placcbo in producing patient-assessed pain relief.Indo- methacini was more effective in relieving pain than flurbiprofen, but it had a much higher incidence of adverse side effects than flurbiprofen, which was similar to placebo.Slight improvement in spinal flexion, straight leg raising, and response to the femoral nerve stretch test was observed with indomethacin and flurbiprofen, but not with placebo.The improvements in each of these manoeuvres could not be considered as clinically important gains.No correlation was found between the response to the anti-inflammatory drugs and the patient's age, sex, or degree of spondylosis as judged by radiographic criteria.How much of the patient response to drugs was due to analgesia and how much was attributable to a direct anti-inflammatory effect could not be gauged by our study. CommentIn our first patient there was no history of rheumatic complaints and no pertinent data to explain the origin of the arthritis; the temporal relation to erythema chronicum migrans and the subsequent disappearance of the symptoms made the diagnosis of Lyme arthritis very likely.It was base-d on clinical evidence as no specific tests are available.4In the second case the diagnosis of Lyme arthritis can only be implied.