Pattern of Lyme arthritis in Europe: report of 14 cases

SUMMARY Fourteen cases of Lyme arthritis are reported. The most frequent picture was that of oligoarthritis appearing in that part of the leg where the cutaneous or neurological complications, or both, of Lyme disease had developed before the arthritis. In most cases recovery followed a single 10 day course of intravenous (IV) penicillin therapy. Arthritis was the presenting feature of Lyme disease in three cases. Definite arthritis was reported frequently in Lyme disease in the USA in the late 'seventies ' and in Europe,2-11 where, however, it seemed to be less severe and less frequent.>i2 In the last two years we have seen 14 cases of Lyme arthritis. We report them here and discuss their prevalence, clinical pattern, and natural evolution. Case reports Fourteen patients (nine female, five male), mean age 40 years (range 12-62), were seen in 1986 and in the first months of 1987. ' The diagnosis of Lyme disease was established on clinical grounds and confirmed by the presence of serum antibodies against Borrelia burgdorferi detected by means of enzyme linked immunosorbent assay (ELISA) (IgG, IgM). Each positive sample was confirmed using an indirect immunofluorescent antibody test (IFAT). A dilution of 1/128 was considered positive. The borrelia strain was supplied by Professor Ackermann (Cologne, West Germany). All our patients suffered from true inflammatory arthritis with synovial swelling. Four had mon-arthritis (knee (n=3); wrist (n = 1)). Eight had oligoarthritis (less than four joints affected), involving mainly the knee, the ankle, and a few metatarsophalangeal joints in the same limb (n=6), or the knee and hip (n=2). Two had polyarthritis involving both knees, ankles, and wrists. Oligo-arthritis always involved that part of the lower lim