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PCR testing for B. burgdorferi DNA not a reliable indicator for active infection in Lyme arthritis
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Detection of Borrelia burgdorferi DNA in synovial fluid may confirm Lyme arthritis; however it is not a reliable indicator of active joint infection, particularly in those with persistent arthritis after antibiotic therapy, according to new findings published in Arthritis and Rheumatism.
“Currently, the primary use for polymerase chain reaction (PCR) testing in Lyme disease is to determine whether patients with persistent arthritis after antibiotic therapy still have active infection,” Allen C. Steere, MD, director of clinical research at Massachusetts General Hospital, and colleagues wrote in the study.
Researchers used PCR B. burgdorferi DNA and RNA to assess spirochetal burden and viability in the skin and joints of 63 patients with Lyme arthritis. Results were then compared with 90 patients with erythema migrans skin lesions, an early disease manifestation.
Positive PCR results for B. burgdorferi were detected in 97% of patients with erythema migrans lesions and in pre-treatment synovial fluid samples of 60% to 70% of patients with Lyme arthritis.
Those with Lyme arthritis were then assigned oral antibiotics for 1 to 2 months and an additional month if arthritis did not resolve. Patients with persistent arthritis received non-steroidal anti-inflammatory drugs (NSAIDs) and disease-modifying antirheumatic drugs (DMARDs).
Positive PCR results persisted for B. burgdorferi a maximum of 11 months in patients with antibiotic-refractory arthritis. However, positive results in the post-antibiotic period did not correlate with relapse or subsequent duration of arthritis, and all findings in synovial tissue were negative at synovectomy, the researchers wrote.
Out of 10 erythema migrans samples, eight tested positive for B. burgdorferi mRNA. Conversely, B. burgdorferi mRNA was detected in zero of 11 synovial fluid samples, even when obtained prior to antibiotics.
“These results suggested that spirochetes in the majority of erythema migrans skin lesions were active and viable, whereas those in synovial fluid were moribund or dead, even prior to antibiotic treatment,” the researchers wrote. “We have published an algorithm for the treatment of such patients that recommends oral antibiotics followed by IV antibiotics for a total of 2 to 3 months followed by DMARD therapy. Although this may result in unnecessarily long antibiotic courses in some patients, it does not seem to result in the error of treating infected patients with DMARDs.”
Li X. Arthritis Rheum. 2011;doi:10.1002/art.30384.
Disclosure: This study was supported by NIH (grant AR-20358), CDC (CCU110 291), the English, Bonter, Mitchell Foundation, the Lyme/Arthritis Research Fund at Massachusetts General Hospital, and the Eshe Fund. Dr. Li received support from the Arthritis Foundation.
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