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Lyme arthritis: Clinical features, serological, and radiographic findings of cases in Germany

Summary

The clinical manifestations, serological data, and radiographic findings of ten cases of Lyme arthritis in Germany are summarized. Qualitative assessment shows that the characteristics of the disease in Germany do not differ fundamentally from those reported in the USA. However, since a serological test for antibodies to the causative spirochete is now available, the great variety of the clinical features of Lyme arthritis can be described more precisely. The cases of chronic Lyme arthritis without prior erythma chronicum migrans, hitherto the most important diagnostic hallmark of the disease, may have been underestimated. One of the cases reported provides evidence that the disease was transmitted via a fly bite. Radiographic abnormalities consisting of marked juxta-articular osteoporosis and osseous erosions were found in two patients with chronic arthritis. Three patients were treated with high-dose intravenous penicillin, two did not respond to the therapy.

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Abbreviations

ECM:

erythema chronicum migrans

NSAID:

nonsteroidal anti-inflammatory drugs

References

  1. Ackermann R, Runne U, Klenk W, Dienst C (1980) Erythema chronicum migrans mit Arthritis. Dtsch Med Wochenschr 105:1779–1781

    Google Scholar 

  2. Ackermann R (1983) Die Spirochäten-Ätiologie des Erythema chronicum migrans und der Meningo-Polyneuritis Garin-Bujadoux-Bannwarth. Fortschr Med 101:1167–1170

    Google Scholar 

  3. Ackermann R, Kabatzki J, Boisten HP, Steere AC, Grodzicki RL, Hartung S, Runne U (1984) Spirochäten-Ätiologie der Erythema-chronicum-migrans-Krankheit. Dtsch Med Wochenschr 109:92–97

    Google Scholar 

  4. Afzelius A (1910) Verhandlungen der dermatologischen Gesellschaft zu Stockholm, Sitzung vom 28. Oktober 1909. Arch Dermatol Syph (Berlin) 101:404

    Google Scholar 

  5. Åsbrink E, Hovmark A, Hederstedt B (1984) The spirochetal etiology of acrodermatitis chronica atrophicans Herxheimer. Acta Derm Venereol (Stockh) 64:506–512

    Google Scholar 

  6. Bannwarth A (1941) Chronisch lymphozytäre Meningitis, entzündliche Polyneuritis und „Rheumatismus“. Arch Psychiatr Nervenkr 113:284–376

    Google Scholar 

  7. Benach JL, Bosler EM, Hanrahan JP, Coleman JL, Habicht GS, Bast TF, Cameron DJ, Ziegler JL, Barbour AG, Burgdorfer W, Edelman R, Kaslow RA (1983) Spirochetes isolated from the blood of two patients with Lyme disease. N Engl J Med 308:740–742

    Google Scholar 

  8. Bowen GS, Griffin M, Hayne C, Slade J, Schulze TL, Parkin W (1984) Clinical manifestations and descriptive epidemiology of Lyme disease in New Jersey, 1978 to 1982. JAMA 251:2236–2240

    Google Scholar 

  9. Brown HW (1975) Stomoxys: stable flies. In: Brown HW (ed) Basic clinical parasitology. Appleton-Century-Crofts, New York, pp 287–288

    Google Scholar 

  10. Burgdorfer W, Barbour AG, Hayes SF, Benach JL, Grunwaldt E, Davis JP (1982) Lyme disease — a tick-borne spirochetosis? Science 216:1317–1319

    Google Scholar 

  11. Charmot G, Rodhain F, Perez C (1982) Un cas d'arthrite observé en France. Nouv Presse Med 11:207–208

    Google Scholar 

  12. Dougados M, Kahan A, Vannier A, Amor B (1983) Arthrite de Lyme. Deux nouveaux cas français. Rev Rhum Mal Osteoartic 50:299–302

    Google Scholar 

  13. Garin C, Bujadoux C (1922) Paralysie par les tiques. J Med Lyon 71:765–767

    Google Scholar 

  14. Gerster JC, Guggi S, Perroud H, Bovet R (1981) Lyme arthritis appearing outside the United States: a case report from Switzerland. Br Med J 283:951–952

    Google Scholar 

  15. Hård S (1966) Erythema chronicum migrans (Afzelii) associated with mosquito bite. Acta Derm Venereol (Stockh) 46:473–476

    Google Scholar 

  16. Hellerström S (1930) Erythema chronicum migrans Afzelii. Acta Derm Venereol (Stockh) 11:315–321

    Google Scholar 

  17. Herzer P, Schattenkirchner M, Zöllner N (1983) Lyme-Arthritis — eine zu selten bedachte Diagnose? Verh dtsch Ges inn Med 89:219–302

    Google Scholar 

  18. Herzer P (1983) Lyme-Krankheit. Eine neue oder neu erkannte klinische Entität. Münch Med Wochenschr 125:737–738

    Google Scholar 

  19. Hollström E (1951) Successful treatment of erythema migrans Afzelius. Acta Derm Venereol (Stockh) 31:235–243

    Google Scholar 

  20. Illouz G, Hewitt J (1981) A propos de l'arthrite de Lyme. Polyarthrite inflammatoire après un érythème annulaire migrant. Rev Rhum Mal Osteoartic 48:813–815

    Google Scholar 

  21. Johnson RC, Schmid GP, Hyde FW, Steigerwalt AG, Brenner DJ (1984) Borrelia burgdorferi sp. nov.: etiologic agent of Lyme disease. Int J Sys Bacteriol 34:496–497

    Google Scholar 

  22. Lawson JP, Steere AC (1985) Lyme arthritis: radiologic findings. Radiology 154:37–43

    Google Scholar 

  23. Mallecourt J, Landureau M, Wirth AM (1982) La maladie de Lyme. Un cas clinique observé en Eure-et-Loire. Nouv Presse Med 11:39–41

    Google Scholar 

  24. Müller W (1984) Die Lyme-Arthritis (Erythema-migrans-Arthritis). Schweiz Med Wochenschr 114:265–269

    Google Scholar 

  25. Pachner AR, Steere AC (1985) The triad of neurologic manifestations of Lyme disease: meningitis, cranial neuritis, and radiculoneuritis. Neurology 35:47–53

    Google Scholar 

  26. Pfister HW, Einhäupl K, Preac-Mursic V, Wilske B (1985) Similarity of neurological manifestations of Borrelia burgdorferi infection in America and Europe. Neurology 35:1393–1394

    Google Scholar 

  27. Preac-Mursic V, Wilske B, Herzer P, Schierz G, Bauer M, von Busch K (1985) Acrodermatitis chronica atrophicans — eine Borreliose. Hautarzt 36:691–693

    Google Scholar 

  28. Reik L, Steere AC, Bartenhagen NH, Shope RE, Malawista SE (1979) Neurologic abnormalities of Lyme disease. Medicine 58:281–294

    Google Scholar 

  29. Russell H, Sampson JS, Schmid GP, Wilkinson HW, Plikaytis B (1984) Enzyme-linked immunosorbent assay and indirect immunofluorescence assay for Lyme disease. J Infect Dis 149:465–470

    Google Scholar 

  30. Ryberg R, Nilsson B, Hindfelt B, Jeppsson PG, Olsson JE, Sörnäs R (1984) Lymphocytic meningoradiculitis (Bannwarth's syndrome) — a Lyme disease variety? Acta Neurol Scand 69 (Suppl 98):343–344

    Google Scholar 

  31. Scrimenti RJ (1970) Erythema chronicum migrans. Arch Dermatol 102:104–105

    Google Scholar 

  32. Steere AC, Malawista SE, Snydman DR, Andiman WA (1976) A cluster of arthritis in children and adults in Lyme, Connecticut. Arthritis Rheum 19:824

    Google Scholar 

  33. Steere AC, Malawista SE, Snydman DR, Shope RE, Andiman WA, Ross MR, Steele FM (1977) Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum 20:7–17

    Google Scholar 

  34. Steere AC, Malawista SE, Hardin JA, Ruddy S, Askenase W, Andiman WA (1977) Erythema chronicum migrans and Lyme arthritis. The enlarging clinical spectrum. Ann Intern Med 86:685–698

    Google Scholar 

  35. Steere AC, Broderick TF, Malawista SE (1978) Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. Am J Epidemiol 108:312–321

    Google Scholar 

  36. Steere AC, Malawista SE (1979) Cases of Lyme disease in the United States: locations correlated with distribution of Ixodes dammini. Ann Intern Med 91:730–733

    Google Scholar 

  37. Steere AC, Gibofsky A, Patarroyo ME, Winchester RJ, Hardin JA, Malawista SE (1979) Chronic Lyme arthritis. Clinical and immunogenetic differentiation from rheumatoid arthritis. Ann Intern Med 90:896–901

    Google Scholar 

  38. Steere AC, Batsford WP, Weinberg M, Alexander J, Berger HJ, Wolfson S, Malawista SE (1980) Lyme carditis: cardiac abnormalities of Lyme disease. Ann Intern Med 93:8–16

    Google Scholar 

  39. Steere AC, Brinckerhoff CE, Miller DJ, Drinker H, Harris ED, Malawista SE (1980) Elevated levels of collagenase and prostaglandin E2 from synovium associated with erosion of cartilage and bone in a patient with chronic Lyme arthritis. Arthritis Rheum 23:591–599

    Google Scholar 

  40. Steere AC, Grodzicki RL, Kornblatt AN, Craft JE, Barbour AG, Burgdorfer W, Schmid GP, Johnson E, Malawista SE (1983) The spirochetal etiology of Lyme disease. N Engl J Med 308:733–740

    Google Scholar 

  41. Steere AC, Hutchinson GJ, Rahn DW, Sigal LH, Craft JE, DeSanna ET, Malawista SE (1983) Treatment of the early manifestations of Lyme disease. Ann Intern Med 99:22–26

    Google Scholar 

  42. Steere AC, Bartenhagen NH, Craft JE, Hutchinson GJ, Newman JH, Rahn DW, Sigal LH, Spieler PN, Stenn KS, Malawista SE (1983) The early clinical manifestations of Lyme disease. Ann Intern Med 99:76–82

    Google Scholar 

  43. Steere AC, Green J, Schoen RT, Taylor E, Hutchinson GJ, Rahn DW, Malawista SE (1985) Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med 312:869–874

    Google Scholar 

  44. Stewart A, Glass J, Patel A, Watt G, Cripps A, Clancy R (1982) Lyme arthritis in the Hunter Valley. Med J Aust 1:139

    Google Scholar 

  45. Weber K, Puzik A, Becker T (1983) Erythema-migrans-Krankheit. Beitrag zur Klinik und Beziehung zur Lyme-Krankheit. Dtsch Med Wochenschr 108:1182–1190

    Google Scholar 

  46. Weber K, Schierz G, Wilske B, Preac-Mursic V (1984) European erythema migrans disease and related disorders. Yale J Biol Med 57:463–471

    Google Scholar 

  47. Wilske B, Schierz G, Preac-Mursic V, Weber K, Pfister HW, Einhäupl K (1984) Serological diagnosis of erythema migrans disease and related disorders. Infection 12:331–337

    Google Scholar 

  48. Wilske B, Münchhoff P, Schierz G, Preac-Mursic V, Roggendorf M, Zoulek G (1985) Zur Epidemiologie der Borrelia burgdorferi-Infektion. Nachweis von Antikörpern gegen Borrelia burgdorferi bei Waldarbeitern aus Oberbayern. Münch Med Wochenschr 127:171–172

    Google Scholar 

  49. Wilske B, Preac-Mursic V, Schierz G (1985) Antigenic heterogeneity of European Borrelia burgdorferi strains isolated from patients and ticks. Lancet I:1099

    Google Scholar 

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Herzer, P., Wilske, B., Preac-Mursic, V. et al. Lyme arthritis: Clinical features, serological, and radiographic findings of cases in Germany. Klin Wochenschr 64, 206–215 (1986). https://doi.org/10.1007/BF01711648

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  • DOI: https://doi.org/10.1007/BF01711648

Key words

  • Lyme arthritis
  • Lyme disease
  • Tickborne spirochetosis
  • Borrelia burgdorferi
  • Stomoxys calcitrans