The long-term clinical outcomes of Lyme disease.

 Ann Intern Med. 1994 Oct 15;121,8:560-7.The long-term clinical outcomes of Lyme 
disease. A population-based retrospective cohort study. Shadick NA, Phillips CB, Logigian EL, 
Steere AC, Kaplan RF, Berardi VP, Duray PH, Larson MG, Wright EA, Ginsburg KS, Katz JN, 
Liang MH.
Department of Rheumatology-Immunology, Brigham & Women's Hospital, Boston, MA 02115.
OBJECTIVE: To ascertain the prevalence of and risk factors for long-term sequelae from acute 
34Lyme disease. DESIGN: Population-based, retrospective cohort study. SETTING: A coastal 
region endemic for Lyme disease. PARTICIPANTS: Patients with a history of Lyme disease who 
were previously treated with antibiotics were compared with randomly selected controls.
MEASUREMENTS: A standardized physical examination, health status measure, Short Form 36, 
psychometric test battery, and serologic analysis. RESULTS: Compared with the control group, n 
= 43, the Lyme group, n = 38; mean duration from disease onset to study evaluation, 6.2 years, 
had more arthralgias, 61% compared with 16%; P < 0.0001; distal paresthesias, 16% compared 
with 2%; P = 0.03; concentration difficulties, 16% compared with 2%; P = 0.03; and fatigue, 26% 
compared with 9%; P = 0.04, and they had poorer global health status scores, P = 0.04. The Lyme 
group also had more abnormal joints, P = 0.02, and more verbal memory deficits, P = 0.01, than 
did the control group. Overall, 13 patients, 34%; 95% CI, 19% to 49%, had long-term sequelae
from Lyme20disease, arthritis or recurrent arthralgias [n = 6], neurocognitive impairment [n = 
4], and neuropathy or myelopathy [n = 3]. Compared with controls, patients who had long-term 
sequelae had higher IgG antibody titers to the spirochete, P = 0.03, and received treatment later, 
34.5 months compared with 2.7 months; P < 0.0001. CONCLUSIONS: Persons with a history of 
Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal 
memory impairment when compared with those without a history of Lyme disease. Our 
findings suggest that disseminated Lyme disease may be associated with long-term morbidity

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