THE T-HELPER CELL RESPONSE IN LYME ARTHRITIS - DIFFERENTIAL RECOGNITION OF BORRELIA-BURGDORFERI OUTER SURFACE PROTEIN-A IN PATIENTS WITH TREATMENT-RESISTANT OR TREATMENT-RESPONSIVE LYME ARTHRITIS

The host response to Borrelia burgdorferi is likely to play a role in the pathogenesis of Lyme arthritis. Whereas most patients with Lyme ar thritis can be cured with antibiotic therapy, similar to 10% of the pa tients have persistent arthritis for months or even several years afte r antibiotic treatment. In this study, we tested the hypothesis that t he T cell response to one or more antigens of B. burgdorferi is differ ent in patients with treatment-responsive or treatment-resistant Lyme arthritis. For this purpose, 313 B. burgdorferi-specific T cell lines were derived from the synovial fluid or peripheral blood of four patie nts with treatment-responsive Lyme arthritis and five patients with tr eatment-resistant arthritis. 87 T cell lines from treatment-responsive Lyme arthritis and 112 lines from the treatment-resistant group were examined for the recognition of five recombinant. B. burgdorferi prote ins: outer surface proteins A (OspA), B, C, p39, and p93. In both grou ps of patients, the T cell lines frequently recognized OspB, and only occasionally recognized OspC, p39, and p93. In contrast, OspA was pref erentially recognized by T cell lines from patients with treatment-res istant arthritis, but only rarely recognized by T cell lines from pati ents with treatment-responsive arthritis (odds ratio 28.4, 95% confide nce interval 9.2-87.8, p<0.005). These results are compatible with the hypothesis that the T cell response to B. burgdorferi OspA is involve d in the pathogenesis of treatment-resistant Lyme arthritis.