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Study: Routine Lyme disease testing not advised in early arthritis without history of tick bite
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The results of a study of patients in France do not support routine testing for Lyme disease in patients with an early onset of inflammatory arthritis impacting more than one joint in the absence of a known tick bite.
Researchers studied data from 810 patients from the ESPOIR multicenter cohort who had a new onset of arthritis for at least 6 weeks to 6 months in at least two joints. Patients were enrolled in 14 clinics in 10 regions of France between December 2002 and March 2005, and had no treatment history with a prior disease-modifying anti-rheumatic drugs or glucocorticoids. Patients were evaluated at baseline and by a rheumatologist every 6 months for 2 years and once a year for 10 years thereafter. In addition to a general physical examination at baseline, patients were screened for blood cell counts and kidney function. Patients also underwent viral serological and urine testing. In addition, researchers assessed patients’ immunoglobulin (Ig)M, IgG and IgA levels; cytokine levels; anti-citrullinated peptide and antinuclear antibodies; and took radiographs of the chest, pelvis, hands and feet.
In 2006, tests for antibodies to Borrelia were routinely performed using enzyme-linked immunosorbent assays (ELISA) to detect IgG and IgM in 99.5% of the cohort. Confirmation using Western blots were not commonly used, the researchers noted.
Researchers found 81.1% of patients tested negative for both IgG and IgM antibodies. Investigators discovered 11.2% of patients had only IgM antibodies, 6% of patients had only IgG antibodies and 1.6% of patients had both IgG and IgM antibodies, yielding 7.2% of patients in whom Lyme disease could not be excluded. At 2-years follow-up, the final diagnoses did not vary between patients with and without positive serological tests, and none received a definitive diagnosis of Lyme disease. After the application of Bonferroni’s correction, the only significant difference between patients was the Ritchie index, with higher scores in the patients with IgG positivity. – by Shirley Pulawski
Disclosures: The researchers report an unrestricted grant from Merck Sharp and Dohme that supported the first 5 years of the ESPOIR cohort study. The biological database was supported in part by two grants from the INSERM. The French Society for Rheumatology, Pfizer, AbbVie and Roche-Chugai also supported the ESPOIR cohort study. Institutional support was received from Abbott for the serological tests. Please see the full study for a list of all other authors’ relevant financial disclosures.
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