THE LONG-TERM CLINICAL OUTCOMES OF LYME-DISEASE - A POPULATION-BASED RETROSPECTIVE COHORT STUDY

Objective: To ascertain the prevalence of and risk factors for long-te rm sequelae from acute Lyme disease. Design: Population-based, retrosp ective cohort study. Setting: A coastal region endemic for Lyme diseas e. Participants: Patients with a history of Lyme disease who were prev iously treated with antibiotics were compared with randomly selected c ontrols. Measurements: A standardized physical examination, health sta tus 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); di stal paresthesias (16% compared with 2%; P = 0.03); concentration diff iculties (16% compared with 2%; P= 0.03); and fatigue (26% compared wi th 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 mo re verbal memory deficits (P = 0.01) than did the control group. Overa ll, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocogniti ve impairment [n = 4], and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG ant ibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001). Conclusions: Pers ons with a history pf Lyme disease have more musculoskeletal impairmen t and a higher prevalence of verbal memory impairment when compared wi th those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.