Background/Purpose

Lyme arthritis is a late manifestation of a tick-transmitted spirotechal infection, mainly caused by Borrelia burdorgferi. Lyme arthritis typically presents as a mono- or oligoarticular arthritis primarily affecting the large joints. However, various presentations including polyarthritis and polyarthralgias are possible (Puius et al.). It results that spirotechal infection is sometimes evoked by the rheumatologist in context of recent-onset arthritis, even in non-endemic regions.

The aim of this study was to determine the utility of systematic Lyme serology in a French cohort of patients with recent-onset arthritis, by determining the seroprevalence of Lyme antibodies according to the region of inclusion, the prevalence of Lyme arthritis and the diagnostic accuracy of serological testing.

Methods

The present study is an ancillary project from a French prospective and multicentric cohort study monitoring clinical, biologic, and radiographic data for patients with inflammatory arthritis lasting 6 weeks to 6 months (Combe et al.). Patients were included during the period of December 2002 to March 2005 in 14 regional centers. Antibodies against Borrelia at baseline were detected in 2006, using an IgG and IgM Immune Assay, from blood samples collected at baseline, without Western blot confirmation. This procedure was conducted independantly of the physician’s strategy to detect a possible spirotechal infection. The final diagnosis was recorded after two years of follow-up. Global and regional seroprevalence of Lyme antibodies were determined. The proportion of patients with a final diagnosis of Lyme arthritis and the diagnostic accuracy of Lyme serology in context of recent-onset arthritis were recorded. The clinical and biological characteristics of patients according to the results of Lyme serology were analyzed in detail.

Results

Among the 814 patients included in the ESPOIR cohort, 810 were tested for the presence of Borrelia antibodies (99.5%). Of these patients, 7,6% had positive serology (62/810) and 2,6% had equivocal results (21/810). Average positivity of Lyme serology varied significantly by region of inclusion (2.4% – 14.9%), the highest value being found in an endemic area. After two-years of follow-up, no cases of definite Lyme arthritis were identified, although it was the main diagnostic hypothesis at baseline for 2 patients. Thus, diagnostic accuracy of lyme serology in context of recent-onset arthritis seems very low despite a relatively high proportion of patients having an IgG positive serology..Additional analyzes revealed an association between the positivity of the immune assay and renal failure (p: 0.0005).

Conclusion

In France, where there is an heterogeneous risk of borrelia infection by region, the diagnosis of polyarthritis linked to borrelia was never considered by the clinician. In contrast, serology, even IgM with positivity, is not rare. This study does not support the routine use of Lyme serology and highlight the risk of difficulty to interpret the results in a context of recent-onset arthritis and confirm the results previously obtained by other authors, in France and in the Netherlands (van Burgel et al, Muller et al.).

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/interest-of-systematic-lyme-serology-in-context-of-recent-onset-arthritis/