Background Borrelia burgdorferi is difficult to detect in synovialfluid, which limits our understanding of the pathogenesis ofLyme arthritis, particularly when arthritis persists despiteantibiotic therapy.
Methods Using the polymerase chain reaction (PCR), we attemptedto detect B. burgdorferi DNA in joint-fluid samples obtainedover a 17-year period. The samples were tested in two separatelaboratories with four sets of primers and probes, three ofwhich target plasmid DNA that encodes outer-surface proteinA (OspA).
Results B. burgdorferi DNA was detected in 75 of 88 patientswith Lyme arthritis (85 percent) and in none of 64 control patients.Each of the three OspA primer-probe sets was sensitive, andthe results were moderately concordant in the two laboratories(kappa = 0.54 to 0.73). Of 73 patients with Lyme arthritis thatwas untreated or treated with only short courses of oral antibiotics,70 (96 percent) had positive PCR results. In contrast, of 19patients who received either parenteral antibiotics or longcourses of oral antibiotics ( 1 month), only 7 (37 percent)had positive tests (P<0.001). None of these seven patientshad received more than two months of oral antibiotic treatmentor more than three weeks of intravenous antibiotic treatment.Of 10 patients with chronic arthritis (continuous joint inflammationfor one year or more) despite multiple courses of antibiotics,7 had consistently negative tests in samples obtained threemonths to two years after treatment.
Conclusions PCR testing can detect B. burgdorferi DNA in synovialfluid. This test may be able to show whether Lyme arthritisthat persists after antibiotic treatment is due to persistenceof the spirochete.
Source Information
From the Divisions of Rheumatology/Immunology (J.J.N., F.D., A.C.S.) and Pediatric Rheumatology (J.J.N., F.D.), New England Medical Center and Tufts University School of Medicine, Boston; and the Sections of Clinical Microbiology, Infectious Diseases, and Experimental Pathology, Mayo Foundation, Rochester, Minn. (B.J.R., P.N.R., D.H.P.).
Address reprint requests to Dr. Nocton at the Division of Rheumatology/Immunology, New England Medical Center, 750 Washington St., Boston, MA 02111.
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