Studies on the pathogenesis and treatment of Lyme arthritis

Lyme arthritis is one of the most common clinical manifestations of Lyme bo rreliosis, It is caused by an intraarticular infection with Borrelia (B.) b urgdorferi. A small number of bacteria are liable to provoke severe arthrit is by inducing mechanisms (including the induction of cytokines and chemoki nes) that amplify the inflammatory response. The cellular immune response a gainst B. burgdorferi is characterised by a predominant T helper cell type 1 (Th1) pattern that appears to be inadequate to overcome the infection. In most cases, Lyme arthritis may be cured by antibiotic therapy. A brief sum mary of current recommendations for the treatment of Lyme arthritis in adul ts and children is given in this article. How ever, about 10% of Lyme arthr itis patients do not respond sufficiently to antibiotic treatment. Two not mutually exclusive pathogenetic concepts of these treatment-resistant cases will be discussed in the present study: persistent infection and infection -induced immunopathology.