Antibody responses to Borrelia burgdorfeti in patients with antibiotic-refractory, antibiotic-responsive, or non-antibiotic-treated lyme arthritis

作者：Kannian Priya; McHugh Gail; Johnson Barbara J B; Bacon Rendi M; Glickstein Lisa J; Steere Allen C^*

来源：Arthritis and Rheumatism, 2007, 56(12): 4216-4225.

DOI：10.1002/art.23135

Objective. To compare the pattern of antibody responses to Borrelia burgdorferi in patients with antibiotic-refractory, antibiotic-responsive, or nonantibiotic-treated Lyme arthritis as an indirect measure of spirochetal persistence or eradication.
Methods. At least 3 serial serum samples from 41 patients with antibiotic- refractory arthritis and 23 patients with antibiotic-responsive arthritis, and samples from 10 non-antibiotic-treated, historical control patients were tested for IgG reactivity with B burgdorferi sonicate and 4 differentially expressed outer surface lipoproteins of the spirochete, by enzyme-linked immunosorbent assay.
Results. Among non-antibiotic-treated patients, antibody titers to B burgdorferi antigens remained high throughout a 2-5-year period of arthritis. In contrast, in patients with antibiotic-responsive arthritis, in whom joint swelling usually resolved during a 1-month course of oral antibiotic therapy, the median antibody titers to most of the spirochetal antigens remained steady or decreased during the first 1-3 months after starting antibiotic therapy. In patients with. antibiotic-refractory arthritis, who had persistent joint swelling for a median duration of 10 months despite 2-3 months of oral or intravenous antibiotics, the median titers to most antigens increased slightly during the first 1-3 months. However, by 4-6 months after starting antibiotic therapy, reactivity with all antigens declined similarly in both antibiotic-treated groups.
Conclusion. Whereas the antibody titers to B burgdorferi remained high in non-antibiotic-treated patients, the titers declined similarly 4-6 months after starting therapy in patients with antibiotic-responsive or a ntibiotic- refractory arthritis, suggesting that synovial inflammation persisted in patients with antibioticrefractory arthritis after the period of infection.

• 出版日期2007-12