Lack of Borrelia burgdorferi DNA in synovial samples from patients with antibiotic treatment-resistant lyme arthritis

Objective, To determine whether Borrelia burgdorferi DNA may be detected in synovial tissue from patients with Lyme arthritis who have persistent syno vial inflammation after antibiotic treatment. Methods. Synovial specimens obtained at synovectomy from 26 patients with a ntibiotic treatment-resistant Lyme arthritis and from 10 control subjects w ere tested for B burgdorferi DNA using 3 primer-probe sets that target gene s encoding outer surface proteins A or B or a flagellar protein (P41) of th e spirochete, Results. The 26 patients with Lyme arthritis, who had received antibiotic t herapy for a mean total duration of 8 weeks prior to synovectomy, and the 1 0 control subjects each had negative polymerase chain reaction (PCR) result s in synovial samples. When the samples were spiked with similar to 1-10 B burgdorferi, all but 1 had positive PCR results, suggesting that spirocheta l DNA could have been detected in most of the unspiked samples if it had be en present. Conclusion. These results indicate that synovial inflammation may persist i n some patients with Lyme arthritis after the apparent eradication of the s pirochete from the joint with antibiotic therapy.