NEW YORK, Feb 01 (Reuters Health) -- The majority of people who contract
Lyme disease tend to do quite well after treatment with antibiotics, according
to a survey of nearly 700 patients with the tick-borne illness.
Overall, people with antibiotic-treated Lyme disease fared just as well as
those without the disease in terms of pain and their ability to perform typical
daily activities, researchers report.
The study results "should reassure both patients and physicians that the
prognosis for most patients with Lyme disease who receive conventional
antimicrobial treatment is excellent," according to study co-author Dr. Eugene
D. Shapiro of Yale University School of Medicine in New Haven, Connecticut, and
colleagues.
Lyme disease is caused by bacteria transmitted via a tick bite and can
result in fatigue, joint pain and difficulty concentrating if left untreated.
Antibiotics can eradicate the bacteria and prevent long-term problems if started
early enough. However, it has not been clear if the symptoms persist in some
people.
The investigators looked at 678 Connecticut residents diagnosed with Lyme
disease between 1984 to 1991 and compared them with 212 people without the
disease. Most of the patients (85%) had been treated with antibiotics.
The researchers found that scores on tests of health-related quality of
life were similar between patients and people without Lyme disease, according to
the report in the February 2nd issue of The Journal of the American Medical
Association.
Although many patients did say they had an increase in symptoms (such as
pain and fatigue) between 1 and 11 years after diagnosis, the frequencies of
such symptoms were equally as common in same-age people without Lyme disease.
In those instances when study subjects did report more symptoms than other
people, the research team found that the study participants did not fit the
criteria for Lyme disease. Only 64% of the patients enrolled in the study as
having Lyme disease actually had all the symptoms that meet the definition for
the disease.
Overall, 69% of the patients reported an increased frequency of symptoms,
such as pain and fatigue, and difficulty performing daily activities following
diagnosis, but only 19% of the patients attributed the problems to Lyme disease,
the authors note.
However, "this study does not indicate that all patients with Lyme disease
have favorable outcomes," Shapiro and colleagues caution. "Indeed, there is good
evidence that in rare instances they may experience complications --
particularly recurrent arthritis in patients who are not treated promptly and
who have a genetic predisposition to develop an autoimmune-mediated arthritis."
The study should discourage physicians from treating patients with some
symptoms of Lyme disease, like fatigue or muscle pain, with antibiotics when the
patients do not have all the symptoms indicative of Lyme disease, according to
Dr. Pierce Gardner of the State University of New York at Stony Brook, who wrote
an editorial accompanying the study.
Most of these patients "don't really have Lyme disease, so their problems
are not improved by treating them for Lyme disease," said Gardner in an
interview with Reuters Health.
Currently, tests for infection with the Lyme disease-bacteria are
unreliable and may indicate a person is infected when, in fact, they are not, or
vice-versa. More accurate tests for the bacteria are on the way and may help
physicians correctly diagnose people with the disease and improve treatment
decisions, according to Gardner.
"These should be out within a year," he said. These "tests would help us
decide which people have Lyme disease and which don't."
