SAT0491 Higher Levels of anti-Borrelia IGG Associate with Arthritis in Lyme Disease at Presentation: A Northern Italy Referral Center Cohort
Authors: A. Berti, M. Felicetti, A. Volpe, R. Bortolotti, F. Cavatorta, G. Barausse, S. Peccatori, L. Leveghi, C. Pedrotti, G. Paolazzi
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> Lyme disease (LD) is a multisystemic infection caused by Borrelia burgdorferi (<i>Bb</i>) <i>sensu lato</i> complex, involving skin, joints, nervous system and heart. <h3>Objectives</h3> To assess clinical and serological data of patients with LD at presentation in an endemic area of Northeast Italy (Trentino), with a special focus on rheumatic manifestation. <h3>Methods</h3> We retrospectively collected clinical data of <i>Bb</i> seropositive patients from 2014 to 2015, tested with ELISA (Enzyme-Linked Immunosorbent Assay) IgM/IgG and Western blot (WB; IgM/IgG immunoblots). Only patients with a LD9 diagnosis confirmed by a trained physician of our center were selected. Other laboratory and instrumental tests (<i>Bb</i>-PCR on synovial fluid, anti-<i>Bb</i> antibodies research on cerebrospinal fluid, etc.) were performed if deemed necessary by clinical judgment. <h3>Results</h3> Seventynine patients resulted seropositive for <i>Bb</i>, but only 54 met the inclusion criteria. Among patients with confirmed LD, 27 (50%) were female, mean age at presentation was 48±21years; children were 12.9%. The main presenting symptom was erythema migrans in 72% of cases (39/54), arthritis in 17% (9/54), flu-like symptoms in 7% (4/54), chronic atrophic acrodermatitis and cognitive dysfunction in 2% of cases (1 patient each). Among arthritis, 89% (8/9) presented with acute knee monoarthritis and one patient with hand PIP arthritis. Other concomitant or further developed manifestations were CNS involvement (2/54), cranial neuropathy (1/54), pleuropericarditis (1/54), I°grade atrioventricular block (1/54), transitory leucopenia (2/54), flu-like symptoms (12/54). All patients received antibiotic treatment: 58% doxycycline, 25% amoxicillin, 5% ceftriaxone (12% not reported). Twentysix (48%) patients remember tickborne bite, with a mean latency of 10.4±16.9 weeks. When compared to the rest of the cohort, patients presenting with arthritis were younger (48y±12 vs 56y±12; p=.04), remember tickborne bite in 22% of cases (2/9; p=ns), and had increased ESR (mm/h, 51.1±36.6 vs 24.3±20.3; p=.03) and CRP levels (mm/L, 19.6±23.3 vs 5.6±10.2; p=.01). Arthritis-presenting LD-patients had higher serum IgG antibody levels if compared to overall non-arthritis presenting LD-patients (124.0 vs 25.5; p&lt;.0004) and to the subset tested for anti-<i>Bb</i> antibodies presence after the 4th week from bite (124.0 vs 29.0, p&lt;.0003; mean latency 7.8±5.9 weeks). <h3>Conclusions</h3> Arthritis is the second most frequent presenting symptoms of LD (17%). Knee monoarthritis is typical, patients affected are younger and only 20% recall a tick bite. We first demonstrated higher levels of serum anti-<i>Bb</i> IgG antibodies in patients presenting with arthritis. This seems not directly related to a longer time from bite to disease development, since anti-<i>Bb</i> IgG levels of patients with arthritis remain significantly higher if selectively compared to patients without arthritis tested for antibodies after the decline of the primary immune response, after 4th week. <h3>References</h3> Guellec D et al. RMD Open. 2016 Jan 11;2(1):e000120 Stinco G et al. ScientificWorldJournal. 2014 Jan 16;2014:414505 <h3>Disclosure of Interest</h3> None declared