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Lyme disease, Fibromyalgia link evaporates

Tuesday 16 December 2014


From MedPage Today:


Warning: Tick Habitat

Lyme Disease, Fibromylagia Link Evaporates

By Wayne Kuznar, Contributing Writer, MedPage Today
Published: Dec 14, 2014

Lyme disease is not a trigger for fibromyalgia, according to a long-term assessment of patients with culture-confirmed Lyme disease.

The prevalence of fibromyalgia among patients with culture-confirmed Lyme disease who were followed at the Lyme Disease Diagnostic Center in Westchester County, N.Y., for up to 20 years was no greater than that in the general population, say investigators at New York Medical College in Valhalla, N.Y., led by Gary P. Wormser, MD.

Earlier studies that suggested that Lyme disease may trigger fibromyalgia were performed before the use of two-tier serologic testing for Lyme disease and therefore may have included patients who did not actually have Lyme disease, the investigators wrote online in Arthritis & Rheumatology. Further, these studies did not follow Lyme disease patients over the long term.

In the current study, 100 patients with a diagnosis of Lyme disease confirmed by recovery of Borrelia burgdorferi from culture -- the gold standard for microbiologic confirmation -- were systematically evaluated for fibromyalgia using both prior and current diagnostic criteria 11 to 20 years after the onset of Lyme disease. At diagnosis, patients were treated with antibiotic regimens consistent with current guidelines.

During 2011 to 2013, patients were evaluated by interview and tender point examination at 18 specific sites to determine if they met the criteria for a diagnosis of fibromyalgia using both the 1990 criteria (including the use of tender point examination) and the 2011 criteria (omission of tender point examination). At least 11 tender points or a total symptom score of 12 or greater was required to diagnose fibromyalgia, lacking an alternate diagnosis to explain symptoms. All 100 patients were interviewed, and 87 had a tender point examination.

The 100 patients had a mean age of 64.9 years at the time of their assessment for fibromyalgia, and 52% were male. The mean duration of follow-up since culture confirmed their Lyme disease diagnosis was 15.4 years (range 11 to 20 years). At least twenty-four of the 100 patients had an additional episode of early Lyme disease (i.e., erythema migrans) during follow-up. Sixteen of the 24 had one additional episode of erythema migrans and eight had two subsequent episodes.

Only one patient met the interview criteria for a diagnosis of fibromyalgia. Only one of the 87 patients who underwent tender point examination had at least 11 tender points. The prevalence is consistent with that in the general population, the authors note.

"Furthermore, at least 24% of our patients experienced a second episode of early Lyme disease associated with erythema migrans during the follow-up period suggesting that repeated episodes of early Lyme disease also infrequently trigger the development of fibromyalgia," according to the authors.

One limitation of the study "is that we cannot exclude that fibromyalgia is triggered, lasts for a period of time and then resolves in some patients beginning at or shortly after the diagnosis of Lyme disease when the patients are most likely to be symptomatic," they wrote. Another potential limitation is selection bias -- 200 patients were enrolled but only 100 returned for follow-up assessment of fibromyalgia.


Wormser disclosed receiving research grants from Immunetics, Inc., Rarecyte, Inc., and bioMérieux SA, and ownership of equity in Abbott. He has been an expert witness in malpractice cases involving Lyme disease, is an unpaid board member of the American Lyme Disease Foundation, has been an expert witness regarding Lyme disease in a disciplinary action for the Missouri Board of Registration for the Healing Arts, and was a consultant to Baxter for Lyme disease vaccine development.

Co-authors of the study reported the following disclosures:

Nadelman disclosed receipt of consulting fees from Guidepoint Global and Decision Resources and has been an expert witness in malpractice cases involving Lyme disease.


Primary source: Arthritis & Rheumatology
Source reference: Wormser Gary P., et al "Long-term assessment of fibromyalgia in patients with culture-confirmed lyme diseaseART 2014; DOI: 10.1002/art.38972.


The above originally appeared here.


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