RT Book, Section
A1 Madoff, Lawrence C.
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1177742360
T1 Spirochetal Infectious Arthritis
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accessmedicine.mhmedical.com/content.aspx?aid=1177742360
RD 2024/04/23
AB Lyme  disease  (Chap.  181)  due  to  infection  with  the  spirochete  Borrelia  burgdorferi  causes  arthritis  in  up  to  60%  of  persons  who  are  not  treated.  Intermittent  arthralgias  and  myalgias—but  not  arthritis—occur  within  days  or  weeks  of  inoculation  of  the  spirochete  by  the  Ixodes  tick.  Later,  there  are  three  patterns  of  joint  disease:  (1)  Fifty  percent  of  untreated  persons  experience  intermittent  episodes  of  monarthritis  or  oligoarthritis  involving  the  knee  and/or  other  large  joints.  The  symptoms  wax  and  wane  without  treatment  over  months,  and  each  year  10–20%  of  patients  report  loss  of  joint  symptoms.  (2)  Twenty  percent  of  untreated  persons  develop  a  pattern  of  waxing  and  waning  arthralgias.  (3)  Ten  percent  of  untreated  patients  develop  chronic  inflammatory  synovitis  that  results  in  erosive  lesions  and  destruction  of  the  joint.  Serologic  tests  for  IgG  antibodies  to  B.  burgdorferi  are  positive  in  more  than  90%  of  persons  with  Lyme  arthritis,  and  an  NAA-based  assay  detects  Borrelia  DNA  in  85%.