Detection of Borrelia burgdorferi by polymerase chain reaction in synovial membrane,

 Ann Rheum Dis. 1998 Feb;57,2:118-21.Detection of Borrelia burgdorferi by polymerase 
chain reaction in synovial membrane, but not in synovial fluid from patients with persisting 
Lyme arthritis after antibiotic therapy. Priem S, Burmester GR, Kamradt T, Wolbart K, Rittig
MG, Krause A.
51Charité University Hospital, Department of Medicine III, Rheumatology and Clinical 
Immunology, Berlin, Germany.
OBJECTIVES: To identify possible sites of bacterial persistence in patients with treatment 
resistant Lyme arthritis. It was determined whether Borrelia burgdorferi DNA may be 
detectable by polymerase chain reaction, PCR, in synovial membrane, SM, when PCR results 
from synovial fluid, SF, had become negative after antibiotic therapy. METHODS: Paired SF 
and SM specimens and urine samples from four patients with ongoing or recurring Lyme 
arthritis despite previous antibiotic therapy were investigated. A PCR for the detection of B 
burgdorferi DNA was carried out using pri mer sets specific for the ospA gene and a p66 gene of 
B burgdorferi. RESULTS: In all four cases, PCR with either primer set was negative in SF and 
urine, but was positive with at least one primer pair in the SM specimens. In all patients arthritis 
completely resolved after additional antibiotic treatment. CONCLUSIONS: These data suggest 
that in patients with treatment resistant Lyme arthritis negative PCR results in SF after 
antibiotic therapy do not rule out the intraarticular persistence of B burgdorferi DNA. 
Therefore, in these patients both SF and SM should be analysed for borrelial DNA by PCR as 
positive results in SM are strongly suggestive of ongoing infectio

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