OP0113 Lyme arthritis in southern norway - an endemic area for lyme borreliosis
Authors: I.J.W. Hansen, S. Noraas, T. Skarpaas, V. Kjelland, G. Haugeberg
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Southern Norway is an endemic area for Lyme borreliosis. IgG antibodies against <i>Borrelia burgdorferi</i> sensu lato (<i>Bb</i>) has been found in approx. 20% of the population (1). The main attention in Norway has been on neuroborreliosis (2). Despite the fact that arthritis is a well-known manifestation of <i>Bb</i> infection there is a lack of data on Lyme arthritis (LA). <h3>Objectives</h3> To characterize patients suggestive of having LA in southern Norway. <h3>Methods</h3> According to protocol patients aged 18 years or older with arthritis with a positive serology for <i>Bb</i> infection (IgG and/or IgM) suspicious of having LA were consecutively recruited either from general practitioners or from our own department. <h3>Results</h3> From January 2007 to December 2010 a total of 27 patients were included. Mean age was 56 years (41–80). Mean symptom duration prior to assessment at department of rheumatology was 11.2 weeks. A history of prior erythema migrans was reported from 7 patients and a known prior tick-bite in 7 patients. Based on overall clinical judgment and <i>Bb</i> diagnostics, 16 patients were classified to have high certainty for LA, 5 to have possible LA and 6 patients were found to have other diagnoses (rheumatoid arthritis 2, psoriasis arthritis 2 and knee osteoarthritis 2). Among the 21 LA patients 20 had mono-arthritis (knee 18, ankle 2) and 1 had polyarthritis. Mean ESR was 31 mm/hr (8-68), CRP 43 mg/L (1-132) and mean white cell count in synovial fluid available from 14 patients was 18 G/L (0-101). Mean level of serum IgG antibodies was 1800% of cut off (700-2550) 8 Patients were IgM positive, 2 patients had inconclusive IgM test. In two LA patients serology results were missing, they were included due detection of <i>Bb</i> in synovial fluid by PCR. <i>Bb</i> DNA was detected in synovial fluid from 12/21 patients by PCR. Among the LA patients 20 were treated with doxycycline for 2-6 weeks and one with cloxacilline and cefotaxime for 14 days each. 7 LA patients had intraarticular glucocorticoid (GC) injection prior to and 1 during antibiotic treatment. All patients responded favorable to GC injection however all relapsed. After first antibiotics had been given 11/16 of patients with a high certainty of having LA had no, 3/16 had one and 2/16 patients had 2 relapses. After antibiotic treatment none developed chronic arthritis. Among the patients with possible LA, 2/5 had no relapse, 1/5 had one relapse and 2/5 got recurrent episodes of joint effusion. These two patients also had severe osteoarthritis. <h3>Conclusions</h3> The predominant clinical presentation of LA in Norwegian adults is mono-arthritis of the knee. None of the patients with high certainty for LA developed chronic arthritis. The detection of <i>Bb</i> by PCR helps to diagnose LA in an endemic area. Our experience is that Lyme disease in Southern Norway is a rather benign disease and may successfully be treated with antibiotics even in patients treated with CS prior to antibiotics. <h3>References</h3> [1]Mygland et al. Eur J Neurol 2006;13:1213–5. [2]Ljostad et al. Lancet Neurol. 2008;7:690-5. <h3>Disclosure of Interest</h3> None Declared