Patients may develop new-onset systemic autoimmune joint diseases—including rheumatoid arthritis (RA), psoriatic arthritis (PsA), or spondyloarthritis (SpA)—following Lyme infection, according to research published in Arthritis & Rheumatology.

Shelia L. Arvikar, MD, of the division of rheumatology, allergy, and immunology at the Center for Immunology and Inflammatory Diseases at Massachusetts General Hospital and Harvard Medical School, Boston, MA, and colleagues conducted a medical record review of all adult patients seen at a single specialty rheumatology clinic between 2003 and 2015. The researchers also analyzed records of patients enrolled in the Lyme arthritis (LA) cohort over a 2 year period (2014-2015) for comparison.

Dr Arvikar and colleagues identified 30 patients (median age 55 years) who had developed new-onset systemic autoimmune joint disease a median of 4 months after Lyme disease; 15 patients with RA, 13 with PsA, and 2 with peripheral SpA. Patients diagnosed with PsA or SpA were found to have had a past medical history significant for psoriasis, axial involvement, or enthesitis.

In the LA cohort (n=43), patients usually presented with monoarticular knee arthritis without prior erythema migrans (EM).  This is in contrast to the systemic autoimmune joint disease cohort in which 57% of patients presented for evaluation with EM lesions, with another 23% presenting with signs consistent with early disseminated Lyme disease without EM lesions. An additional 5 had flu-like symptoms during summer months, and 2 had manifestations of neuroborreliosis. The final 6 patients had LA followed by the onset of RA (n=3) and PsA (n=3). To compare, only 5% of the LA group presented with typical LM lesions prior to arthritis (P <.0001). Only 16% had summer flu-like symptoms, and only 9 of 43 patients had signs of early Lyme disease (P <.0001).


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“The number of patients [with LA] that we have evaluated has steadily increased over the past 13 years,” Dr Arvikar and colleagues wrote. “Moreover, during the most recent 3-year period, the proportion of patients in whom we diagnosed a systemic autoimmune joint disease following Lyme infection increased even more.”

“It is important for clinicians to be aware that a spectrum of infectious and autoimmune joint disorders may occur within the context of Lyme disease: patients may have active B. burgdorferi infection in joints, they may have antibiotic-refractory Lyme synovitis, or…another form of autoimmune arthritis following Lyme disease,” the researchers concluded.

Disclosures: Dr Steere receives support from NIH R01 (AI-110175), English, Bonter, Mitchell Foundation, Ounsworth-Fitzgerald Foundation, Littauer Foundation, Lillian B. Davey Foundation, and the Eshe Fund.

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Reference

Arvikar SL, Crowley JT, Sulka KB, Steere AC. Autoimmune arthritides, rheumatoid arthritis, psoriatic arthritis, or peripheral spondyloarthropathy, following lyme disease. Arthritis Rheumatol. 2016 Sep 16. doi: 10.1002/art.39866 [Epub ahead of print]