Chronic Lyme disease: Is it real?
In most patients, the bacteria that causes Lyme disease doesn't persist after antibiotics, but there are a few patients who have lingering, painful symptoms.
Tue, May 29, 2012 at 08:57 AM
A tiny tick is at the center of a big debate among some physicians.
Lyme disease — so named because it was first reported here in 1975 in Old Lyme, Conn. — is a well-documented tick-borne disease, with more than 30,000 reported cases each year.
The telltale symptom of Lyme disease is a red, circular “bulls-eye” rash that appears five to 14 days after infection. Other symptoms include fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes.
Related: What is Lyme disease?
While most patients diagnosed with Lyme disease respond quickly to a short course of antibiotics, a few patients have persistent, lingering symptoms. Some physicians maintain those patients suffer from chronic Lyme disease and require extended treatment with antibiotics.
But does chronic Lyme disease even exist?
The mainstream school of thought is “no.”
Chronic Lyme disease “is a label used very liberally,” says Dr. Paul Auwaerter, an associate professor of medicine at the Johns Hopkins University School of Medicine who also serves as the clinical director for the Division of Infectious Diseases.
There is no sound scientific evidence that the bacteria that causes Lyme disease – Borrelia burgdorferi – persists after a two- to four-week treatment with antibiotics, says Auwaerter, a board member of the Infectious Diseases Society of America.
Studies funded by the National Institute of Allergy and Infectious Diseases have failed to demonstrate that prolonged antibiotic therapy is beneficial to those who report symptoms such as chronic fatigue, persistent pain and impaired cognitive function.
There are rare cases of post-Lyme disease syndrome, but treatment, Auwaerter and others say, should target the specific symptoms.
Dr. Steven Soloway, a board-certified rheumatologist in Vineland, N.J., says some patients develop arthritic symptoms after being treated for Lyme disease, but that the treatment is similar to that for someone with rheumatoid arthritis.
“We don’t keep on giving antibiotics,” says Soloway.
Soloway says such use of antibiotics carries risks that include creation of drug-resistant bacteria.
But Dr. Daniel J. Cameron, writing in the journal Interdisciplinary Perspectives on Infectious Diseases, argues that “the risk to society of emerging antibiotic-resistant organisms should be weighed against the societal risks associated with failing to treat an emerging population saddled with chronic Lyme disease.”
There is enough evidence of chronic Lyme disease “that can we at least accept that it is a problem,” says Cameron, who has a practice in Mount Kisco, N.Y., 45 miles north of New York City.
“Denying the existence and severity of [chronic Lyme disease] will continue to hinder the efforts to find a solution,” Cameron writes.
At the very least, Cameron says in a telephone interview, there is a need for more research. Earlier studies on the effectiveness of long-term use antibiotics “aren’t that good” — a view shared by Dr. Samuel Shor, an internal medicine physician in Reston, Va., and an associate clinical professor at George Washington University Health Care Sciences. (Watch a video of Shor making the case for chronic Lyme disease.)
Shor notes that just 222 patients were involved in the studies cited by the National Institute of Allergy and Infectious Diseases.
“It’s a small group from which they are generating these dogmatic conclusions,” says Shor.
And he points out that the Institute of Medicine in 2011 issued a report on Lyme disease stating, “significant gaps in knowledge exist that require new studies and research.”
Many patients diagnosed with chronic fatigue syndrome, Shor says, may instead have active chronic Lyme disease. Shor says he has patients with debilitating symptoms for years respond to a course of antibiotics.
Such treatments “are not independent of other supportive management,” he adds. A patient complaining of joint pain or sleep problems would be treated for those issues while the antibiotics are taking hold.