Lyme disease: “End of the debate?” - 05/06/21
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Highlights |
• | Lyme disease is a vector-borne infectious disease (Borreliella) transmitted by ticks (Ixodes ricinus) present in metropolitan France. |
• | The primary clinical manifestation of Lyme disease is erythema migrans. |
• | In the presence of nonmetabolic, nonseptic monoarthritis of the knee, or summertime radiculitis of a lower limb, rheumatologists should suspect Lyme disease. |
• | Lyme disease serology is reliable in the case of arthritis, while Borrelia DNA detection in synovial fluid by PCR is inconsistent (40%). |
Abstract |
Lyme borreliosis is a tick-borne disease that is widespread throughout the northern hemisphere. Ixodes ricinus is present throughout metropolitan France, except for the Mediterranean region. The debate revolves around whether or not a chronic form of Lyme disease exists. This controversy is not limited to France but has been reported worldwide. In France, in 2019, 24 scientific societies representing the medical disciplines most involved in Lyme disease, including the Société Française de Rhumatologie (French Rheumatology Society [SFR]) and the Société de Pathologie Infectieuse de la Langue Française (French Infectious Disease Society–SPILF), published recommendations on the management of Lyme borreliosis following a submission to the Director General of Health. These recommendations conflict with those of the Haute Autorité de Santé (HAS), a multi-specialties independent group of physician, on a key point: whether to add a new nosological entity labeled as “persistent polymorphous signs and symptoms (or syndrome) possibly due to tick bite.” The creation of this new syndrome risks should increase anchoring bias, leading to the attribution of all symptoms to a possible tick bite, without considering differential diagnoses. Lyme disease has been extensively studied. Erythema migrans is the primary clinical manifestation. In the presence of nonmetabolic, nonseptic monoarthritis involving the knee or radiculitis of a lower limb during the summer, Lyme disease should be suspected. Serologic testing for Lyme disease is reliable in the case of late forms such as chronic arthritis, while the detection of Borrelia DNA in synovial fluid by PCR is inconsistent. Sometimes, the serology can be misleading in early forms such as radiculitis. Treatment is based on doxycycline for 14 days in early forms (radiculitis), or 28 days in late forms (arthritis). Arthritis can persist or recur after antibiotic therapy. The prevalence of a diffuse polyalgia syndrome (fibromyalgia) following Lyme disease does not seem to differ much from that in the general population. It is not improved by prolonged antibiotic therapy, which is therefore not recommended.
Le texte complet de cet article est disponible en PDF.Keywords : Lyme disease, Arthritis, Radiculitis, Erythema migrans, Recommendations
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Vol 88 - N° 4
Article 105181- juillet 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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