When Lyme Lingers
Looking back on how such a genetic variation might have evolved, Steere believes something happened in Europe that killed off people who didn’t have the mutated gene, which may have helped others survive the plague or another deadly contagion. But it’s a disadvantage with Borrelia burgdorferi because it leads to greater inflammation that may not be dampened even when antibiotics have killed off the spirochetes.
Intense inflammation in joints and the difficulty in controlling it set the scene for a third complication: the potential for an autoimmune reaction. In studies published in the journal Arthritis & Rheumatism in 2013 and 2014, MGH researchers reported the identification of the first autoantigen known to trigger autoimmune damage in some patients with antibiotic-refractory Lyme arthritis. An autoantigen is a human protein that comes under attack from a patient’s own immune system. That never happens under normal circumstances, but it may occur within an area of intense inflammation, and in Lyme arthritis, this immune attack can obliterate small blood vessels within the joint.
In another puzzling development, someone who has had Lyme disease will develop pain, neurocognitive symptoms or fatigue, a condition sometimes called post-Lyme disease syndrome. In some patients, symptoms of headache, joint pain and fatigue, which typically occur with early Lyme disease, may persist for weeks or months after standard antibiotic therapy and then go away. However, unlike patients with antibiotic-refractory Lyme arthritis, these patients don’t have swollen, inflamed joints.
In still another variation, a small percentage of patients, after feeling well for several months following treatment, will have diffuse pain, difficulty concentrating, or incapacitating fatigue that continues indefinitely. Here, too, standard tests don’t show inflammation, and anti-inflammatory therapies often don’t help much. Four double-blind, placebo-controlled trials involving such patients failed to show sustained benefits of additional antibiotic therapy. That leaves few options for effective treatment.