Leonard H. Sigal, MD, FACP, FACR
Division of Rheumatology
UMDNJ - Robert Wood Johnson
Medical School
New Brunswick, NJ
Summary Points
- The term “chronic Lyme disease” is being
used to categorize patients with chronic nonspecific symptoms and justify
long-term antibiotic treatment.
- The true diagnosis of Lyme disease is made by
recognizing certain objective clinical features accompanied by serological
evidence of previous infection.
- There are no controlled studies confirming the
benefit of long-term antibiotic treatment in “chronic” Lyme disease.
Introduction
Without careful definition of syndromes, the
epidemiologic or clinical studies needed to identify early (and all) clinical
features, determine prognosis, and ascertain appropriate therapies cannot be
performed. Ultimately, “evidence-based medicine” improves the patient’s
health and outcome and the clinician’s confidence and expertise. Syndromes
with pathognomonic features are easier to define and study, but those defined
purely by subjective complaints without objective findings (lacking definite
findings on physical exam or a specific laboratory abnormality) require strict
definitions. Without strict definitions, such syndromes become amorphous and
impossible to grasp. There are many patients suffering with nonspecific symptoms
-- headaches, achiness, lack of concentration, and poor sleep. Many times, these
symptoms are associated with psychological features, such as anxiety and
depression. In an attempt to explain and treat some of these patients, a variety
of labels have emerged -- chronic brucellosis, chronic EBV infection, chronic
fatigue syndrome, fibromyalgia, and, for some, more recently chronic Lyme
disease (1,2). Chronic Lyme disease will be discussed in more detail.
