Antibody responses to Borrelia burgdorferi in patients with antibiotic‐refractory, antibiotic‐responsive, or non–antibiotic‐treated lyme arthritis

Abstract

Objective. To compare the pattern of antibody responses to Borrelia burgdorferi in patients with antibiotic-refractory, antibiotic-responsive, or nonantibiotic-treated Lyme arthritis as an indirect measure of spirochetal persistence or eradication.Methods. At least 3 serial serum samples from 41 patients with antibiotic-refractory arthritis and 23 patients with antibiotic-responsive arthritis, and samples from 10 non-antibiotic-treated, historical control patients were tested for IgG reactivity with B burgdorferi sonicate and 4 differentially expressed outer surface lipoproteins of the spirochete, by enzyme-linked immunosorbent assay.Results. Among non-antibiotic-treated patients, antibody titers to B burgdorferi antigens remained high throughout a 2-5-year period of arthritis. In contrast, in patients with antibiotic-responsive arthritis, in whom joint swelling usually resolved during a 1-month course of oral antibiotic therapy, the median antibody titers to most of the spirochetal antigens remained steady or decreased during the first 1-3 months after starting antibiotic therapy. In patients with antibiotic-refractory arthritis, who had persistent joint swelling for a median duration of 10 months despite 2-3 months of oral or intravenous antibiotics, the median titers to most antigens increased slightly during the first 1-3 months. However, by 4-6 months after starting antibiotic therapy, reactivity with all antigens declined similarly in both antibiotic-treated groups.Conclusion. Whereas the antibody titers to B burgdorferi remained high in non-antibiotic-treated patients, the titers declined similarly 4-6 months after starting therapy in patients with antibiotic-responsive or antibiotic-refractory arthritis, suggesting that synovial inflammation persisted in patients with antibioticrefractory arthritis after the period of infection.

Reply to letter by Volkman commenting on the possible onset of seronegative disease in Lyme arthritis

“…However, in a small percentage of patients, the early period of infection is asymptomatic, and arthritis is the presenting manifestation of the illness. This was the case in the majority of the patients in our study, all of whom were seen from 1987 through 2005 (2). In such patients, the duration of infection prior to arthritis cannot be calculated with certainty.…”

Cardiac manifestations of borreliosis in a dog: a case report

“…The higher IgG in the 2 nd and 3 rd stages is consistent with the clinical signs, especially the cardiovascular ones, and is highly suggestive of borrelia-induced heart disease. The gradual decrease in the patient's antibodies may be due to a chronic subclinical phase of the disease, or to the normal dynamics of immunological recovery, as reported in human beings and other animals (Ogrinc et al, 2002;Kannian et al, 2007).…”

Seronegative disease after inadequate therapy in lyme arthritis: Comment on the article by Kannian et al

“…This lack of TNF binding is particularly striking for mutations affecting cysteine residues, including the C88Y (3) and C88R (5) mutations (C88 forms a disulfide bond with C73 in WT TNFRI). Thus, we suspect that even if C73R is expressed on the surface of PBMCs, it is unlikely to contribute to the increased responsiveness to TNF by PBMCs from TRAPS patients with the C73R mutation, as observed by Nedjai et al (1).…”

“…We read with interest the article by Nedjai et al describing the effects of mutant forms of tumor necrosis factor receptor I (TNFRI) associated with TNFR-associated periodic syndrome (TRAPS) on NF-B activation and surface expression of TNFRI by peripheral blood mononuclear cells (PBMCs) (1). TRAPS-associated TNFRI mutations are autosomal dominant, and patients are heterozygous for mutant and wild-type (WT) TNFRI.…”