Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease.
Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease.
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DOI：
10.1002/art.39866
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发表时间：
2017-01
影响因子：
13.3
通讯作者：
Steere, Allen C.
中科院分区：
文献类型：
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作者：
Arvikar, Sheila L.;Crowley, Jameson T.;Sulka, Katherine B.;Steere, Allen C.
描述莱姆病后的全身性自身免疫性关节疾病，并将其临床特征与莱姆关节炎进行比较。我们回顾了13年来我们莱姆氏关节炎诊所所有成年患者的记录，在这些患者中，我们诊断为莱姆病后的系统性自身免疫性关节疾病。为了进行比较，我们分析了最近两年期间莱姆关节炎(LA)队列中登记的患者的记录。检测伯氏疏螺旋体和3种莱姆病相关自身抗原的抗体。我们确定了30名患者，他们在莱姆病后4个月出现了新发的系统性自身免疫性关节疾病，通常是移行性红斑(EM)。类风湿性关节炎(RA)15例，银屑病关节炎(PSA)13例，外周脊椎关节病(SpA)2例。这30名患者通常患有多发性关节炎；而那些患有PSA/SpA的患者通常有牛皮癣、轴突受累或末端炎的病史。在43例LA患者的对照组中，通常的临床表现是没有EM病史的单关节膝关节炎。大多数全身性自身免疫性疾病患者的伯氏杆菌抗体检测呈阳性，但与LA患者相比，他们的莱姆病相关自身抗体滴度和频率都显著降低。在我们的评估之前，患者经常接受额外的抗生素来治疗推定的莱姆关节炎，但没有好处。我们开了抗炎疗法，最常见的是抗风湿病药物(DMARDS)，结果有所改善。全身性自身免疫性关节疾病，如RA、PSA/SpA，可能伴随着莱姆病。经抗生素治疗的移行性红斑、既往牛皮癣或低滴度伯氏杆菌抗体后发生的多发性关节炎是正确诊断的线索。
To describe systemic autoimmune joint diseases following Lyme disease and to compare their clinical features with Lyme arthritis. Records of all adult patients referred to our Lyme arthritis clinic over a 13-year period in whom we diagnosed a systemic autoimmune joint disease following Lyme disease were reviewed. For comparison, records of patients enrolled in our Lyme arthritis (LA) cohort over the most recent 2-year period were analyzed. IgG antibodies to Borrelia burgdorferi and to 3 Lyme disease-associated autoantigens were measured. We identified 30 patients who developed a new-onset systemic autoimmune joint disorder a median of 4 months after Lyme disease, usually erythema migrans (EM). Fifteen had rheumatoid arthritis (RA), 13 had psoriatic arthritis (PsA), and 2 had peripheral spondyloarthropathy (SpA). The 30 patients typically had polyarthritis; and those with PsA/SpA often had previous psoriasis, axial involvement, or enthesitis. In the comparison group of 43 LA patients, monoarticular knee arthritis, without prior EM, was the usual clinical picture. Most systemic autoimmune patients had positive tests for B. burgdorferi IgG antibodies by ELISA, but they had significantly lower titers and lower frequencies of Lyme-associated autoantibodies than LA patients. Prior to our evaluation, the patients often received additional antibiotics for presumed Lyme arthritis without benefit. We prescribed anti-inflammatory therapies, most commonly disease modifying anti-rheumatic drugs (DMARDs), resulting in improvement. Systemic autoimmune joint diseases, RA, PsA/SpA, may follow Lyme disease. Development of polyarthritis after antibiotic-treated erythema migrans, previous psoriasis, or low-titer B. burgdorferi antibodies are clues to the correct diagnosis.
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影响因子：
--
作者：
Myasoedova, Elena;Crowson, Cynthia S.;Kremers, Hilal Maradit;Therneau, Terry M.;Gabriel, Sherine E.
通讯作者：
Gabriel, Sherine E.
影响因子：
4.9
作者：
Arvikar SL;Collier DS;Fisher MC;Unizony S;Cohen GL;McHugh G;Kawai T;Strle K;Steere AC
通讯作者：
Steere AC
影响因子：
13.3
作者：
Bockenstedt, Linda K.;Wormser, Gary P.
通讯作者：
Wormser, Gary P.
影响因子：
11.8
作者：
Kalish, RA;McHugh, G;Steere, AC
通讯作者：
Steere, AC
影响因子：
13.3
作者：
Londono, Diana;Cadavid, Diego;Drouin, Elise E.;Strle, Klemen;McHugh, Gail;Aversa, John M.;Steere, Allen C.
通讯作者：
Steere, Allen C.