Musculoskeletal and Neurologic Outcomes in Patients with Previously Treated Lyme Disease

Background: Previous follow-up studies of patients with Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity. Objective: To determine clinical and functional outcomes in persons who were treated for Lyme disease in the late 1980s. Design: Population-based, retrospective cohort study. Setting: Nantucket Island, Massachusetts. Participants: 186 persons who had a history of Lyme disease (case-patients) and 167 persons who did not (controls). Measurements: Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-Item Short Form Health Survey [SF-36]), mood state assessment (Profile of Mood States), neurocognitive tests, and serologic examination. Results: The prevalence of Lyme disease among adults on Nantucket Island was estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous Lyme disease (mean time from infection to study evaluation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impairment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0.003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P [is less than] 0.001) than persons without previous Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the performance of the two groups on neurocognitive tests did not significantly differ. Conclusions: Because persons with previous Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.
People with Lyme disease who are treated may have some recurring symptoms but will not develop serious musculoskeletal or neurologic problems. This was the conclusion of researchers who compared functional status and intellectual function in 186 people with a history of Lyme disease and 167 people who did not. There was no difference in intellectual function or musculoskeletal problems in the two groups. However, Lyme patients who were not successfully treated still had occasional symptoms such as fever, headache, photosensitivity or neck stiffness.