Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthriti

 N Engl J Med.  Jan 27; 330,4:282-3.Detection of Borrelia burgdorferi DNA by polymerase 
chain reaction in synovial fluid from patients with Lyme arthritis.  Nocton JJ, Dressler F, 
Rutledge BJ, Rys PN, Persing DH, Steere AC.
Division of Rheumatology/Immunology, New England Medical Center, Boston, MA 02111.
BACKGROUND. Borrelia burgdorferi is difficult to detect in synovial fluid, which limits our 
understanding of the pathogenesis of Lyme arthritis, particularly when arthritis persists 
despite antibiotic therapy. METHODS. Using the polymerase chain reaction, PCR, we 
attempted to detect B. burgdorferi DNA in joint-fluid samples obtained over a 17-year period. 
The samples were tested in two separate laboratories with four sets of primers and probes, three 
of which target plasmid DNA that encodes outer-surface protein A, OspA. RESULTS. B. 
burgdorferi DNA was detected in 75 of 88 patients with Lyme arthritis (85 percent) and in 
none of 64 control patients. Each of the three OspA primer-probe sets was sensitive, and the 
32results were moderately concordant in the two laboratories, kappa = 0.54 to 0.73. Of 73 patients 
with Lyme arthritis that was untreated or treated with only short courses of oral antibiotics, 
70, 96 percent, had positive PCR results. In contrast, of 19 patients who received either 
parenteral antibiotics or long courses of oral antibiotics, > or = 1 month, only 7, 37 percent, 
had positive tests, P < 0.001. None of these seven patients had received more than two months of 
oral antibiotic treatment or more than three weeks of intravenous antibiotic treatment. Of 10 
patients with chronic arthritis, continuous joint inflammation for one year or more, despite 
multiple courses of antibiotics, 7 had consistently negative tests in samples obtained three months 
to two years after treatment. CONCLUSIONS. PCR testing can detect B. burgdorferi DNA in 
synovial fluid. This test may be able to show whether Lyme arthritis that persists after 
antibiotic treatment is due to persistence of the spirochete.




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