All Posts Tagged With: "Lyme arthritis"

Linda’s comment…Evidence is emerging for differential pathogenicity among Borrelia burgdorferi genotypes in the United States. By using two linked genotyping systems, ribosomal RNA intergenic spacer type (RST) and outer surface protein C (OspC), we studied the inflammatory potential of B. burgdorferi genotypes in cells and patients with erythema migrans or Lyme arthritis.

Link: http://www.ncbi.nlm.nih.gov/pubmed/21641395

Excerpt:

Differences among genotypes were not as great in patients
with Lyme arthritis, but those infected with RST1 strains more often had
antibiotic-refractory arthritis. Thus, the B. burgdorferi RST1 (OspC type A)
genotype, followed by the RST3 (OspC type I) genotype, causes greater
inflammation and more severe disease, establishing a link between spirochetal
virulence and host inflammation

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21217173&retmode=ref&cmd=prlinks

Excerpt:

Antibiotic-refractory Lyme arthritis may result from Borrelia
burgdorferi-induced autoimmunity in affected joints. Such patients usually
have certain HLA-DRB1 molecules that bind an epitope of B. burgdorferi
outer-surface protein A (OspA), and cellular and humoral immune responses to
OspA are greater in patients with antibiotic-refractory arthritis than in
those with antibiotic-responsive arthritis. Recent work in a mouse model
suggests that, during B. burgdorferi infection, OspA in genetically
susceptible individuals stimulates a particularly strong T(H)1 response,
which may be one of several factors that can help set the stage for a
putative autoimmune response in affected joints. However, vaccination with
OspA did not induce arthritis in this mouse model, and case and control
comparisons in human vaccine trials did not show an increased frequency of
arthritis among OspA-vaccinated individuals.
Thus, a vaccine-induced immune response to OspA does not replicate the
sequence of events needed in the natural infection to induce
antibiotic-refractory Lyme arthritis.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=21173795&retmode=ref&cmd=prlinks

Excerpt:

Background A 71-year-old woman presented to a rheumatologist with what she
believed to be a 2-year history of Lyme disease, progressing from erythema
migrans to Lyme arthritis.Investigations History, physical examination and
serologic testing confirmed the diagnosis of Lyme disease.Diagnosis Lyme
disease.Management The patient refused antibiotic therapy during the first 2
years of her illness. During the next 2 years, she consulted a
rheumatologist, but declined antibiotic therapy. She continued to have
recurrent episodes of arthritis, following which she was successfully
treated with doxycycline, given initially for 2 weeks, with a second, 4-week
cycle administered 2 months later.
This case illustrates the natural history of untreated Lyme disease, which
is rarely observed in most patients since diagnosis almost always leads to
successful antibiotic treatment. Furthermore, this case also demonstrates
that infection with Borrelia burgdorferi can persist for years in untreated
patients; however, antibiotic therapy is still likely to be effective,
despite long-term infection.

Link: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20921145&retmode=ref&cmd=prlinks

Excerpt:

Borrelia burgdorferi stimulates a strong inflammatory response
during infection of a mammalian host. To understand the
mechanisms of immune regulation employed by the host to control
this inflammatory response, we focused our studies on
adrenomedullin, a peptide produced in response to bacterial
stimuli that exhibits antimicrobial activity and regulates
inflammatory responses by modulating the expression of
inflammatory cytokines. Specifically, we investigated the effect
of B. burgdorferi on the expression of adrenomedullin as well as
the ability of adrenomedullin to dampen host inflammatory
responses to the spirochete. The concentration of adrenomedullin
in the synovial fluid of untreated Lyme arthritis patients was
elevated compared with control osteoarthritis patient samples. In
addition, co-culture with B. burgdorferi significantly increased
the expression of adrenomedullin in RAW264.7 macrophages through
MyD88-, PI3-K-, and p38-dependent signaling cascades.
Furthermore, the addition of exogenous adrenomedullin to B.
burgdorferi-stimulated RAW264.7 macrophages resulted in a
significant decrease in the induction of pro-inflammatory
cytokines. Taken together, these results suggest that B.
burgdorferi increases the production of The role of adrenomedullin in Lyme disease.

Full article: http://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=20828409&retmode=ref&cmd=prlinks

Excerpt:

RESULTS: In patients with Lyme arthritis, B. burgdorferi but not
IFN-gamma induced PBMC to secrete CCL4 and CCL2, and B.
burgdorferi and IFN-gamma each stimulated the production of CXCL9
and CXCL10. However, with the
CD14+ cell fraction, B. burgdorferi alone stimulated the
secretion of CCL4; B.
burgdorferi and IFN-gamma together induced CCL2 secretion, and
IFN-gamma alone stimulated the secretion of CXCL9 and CXCL10. The
percentage of T cells expressing CXCR3 or CCR5 was significantly
greater in SFMC than PBMC, confirming that TH1 effector cells
were recruited to inflamed joints. However, when stimulated with
B. burgdorferi or IFN-gamma, SFMC and PBMC responded similarly.

CONCLUSIONS: B. burgdorferi stimulates PBMC or CD14+
monocytes/macrophages directly to secrete CCL4, but spirochetal
stimulation of other intermediate cells, which are present in
PBMC, is required to induce CD14+ cells to secrete CCL2, CXCL9
and CXCL10. We conclude that B. burgdorferi stimulates
monocytes/macrophages directly and indirectly to guide innate and
adaptive immune responses in patients with Lyme arthritis.

Excerpt:

To report on the differential diagnosis of lyme arthritis and synovial hemangioma due to similar clinical and radiological signs and symptoms. A 15-year-old boy presented at the age of 9 with recurrent rather painless swelling of the right knee. Altogether four episodes lasting for 1-2 weeks each occurred over a period of 18 months before medical advice was sought. Physical examination revealed only a slightly limited range of motion. Living in an endemic area of borreliosis, he reported a tick bite 6 months prior to onset of his symptoms with erythema migrans and was treated for 10 days with amoxicillin. Serology revealed two positive unspecific bands in IgG immunoblot (p41 and 66) with slight positivity for ELISA. Ultrasound revealed synovial thickening and increased fluid. Despite the weak positive serology a diagnosis of lyme arthritis could not be excluded and intravenous antibiotic treatment with ceftriaxone was started. After two further relapses antiinflammatory therapy including intraarticular steroids were introduced with no long lasting effect. A chronical disease developed with alternate periods of swelling and almost complete remission. Ultrasound as well as MRI demonstrated ongoing signs of synovitis, therefore after further progression, a diagnostic arthroscopy was performed showing an inconspicuous knee joint. A second MRI showed focal suprapatellar enhancement and was followed by open arthrotomy revealing a histopathological proven synovial cavernous juxtaarticular hemangioma. To our knowledge, the differential diagnosis of lyme arthritis and synovial hemangioma has not yet been reported despite obvious clinical similarities. In conclusion, in children and adolescents synovial hemangioma has to be considered in differential diagnosis of recurrent knee swelling. Early diagnosis is important to prevent prolonged suffering from chronic joint swelling with probable joint damages, unnecessary treatment procedures and as well school and sports absenteeism.

Excerpt:

Lyme arthritis in dogs can be induced under experimental and
natural conditions.
However, the veterinary relevance of canine borreliosis is still
under extensive investigation. The prevalence of symptoms is
clearly low although the risk of tick exposure is high. Current
research focuses on case definitions, methods for diagnosing
clinical disease in dogs, and discrimination between an immune
response to a natural infection versus vaccination.
In this experimental study,
23 dogs raised under tick-free conditions were allocated to two
groups: 11 dogs were vaccinated with a commercial borrelia
vaccine and subsequently developed detectable antibody titers; 12
were walked in a tick-endemic area on two consecutive days. On
day five after exposure engorged ticks were removed from the 12
dogs and analyzed for Borrelia DNA in real-time PCR assay. Blood
samples were taken before exposure/vaccination and at defined
time points thereafter.

PURPOSE OF REVIEW:
Borrelia burgdorferi colonization of the joints induces an inflammatory response, which in some individuals progresses to chronic arthritis. In this review, we discuss novel pathways that are implicated in disease development by modulating host defenses to B. burgdorferi infection.

SUMMARY: The cause and pathogenesis of Lyme arthritis are complex. Elucidating the mechanisms that govern this chronic inflammatory response will provide direct insights into other infectious arthritides and the development of novel therapeutic approaches against B. burgdorferi infection.

Full article: http://www.newsobserver.com/2010/03/18/394678/lyme-disease-found-in-wake.html#ixzz0iaCT9D44

Excerpt:

RALEIGH — As the weather warms and walks through tick-laden woods beckon, state officials have confirmed that Wake County is among the North Carolina counties where Lyme disease is a known threat.

The state Department of Health and Human Services said Wednesday that in 2009 two cases of the tick-borne disease were found in patients who had not left the county during the 30 days before they contracted the infection.

Four similar cases were confirmed in the state last year, health officials said: one each in Wilkes, Wilson, Pitt and Carteret counties.

Excerpt:

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.