Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease

Background: Previous follow-up studies of patients with Lyme disease sugges t that disseminated infection may be associated with long-term neurologic a nd musculoskeletal morbidity. Objective: To determine clinical and functional outcomes in persons who wer e treated for Lyme disease in the late 1980s. Design: Population-based, retrospective cohort study. Setting: Nantucket Island, Massachusetts. Participants: 186 persons who had a history of Lyme disease (case-patients) and 167 persons who did not (controls). Measurements: Standardized medical history, physical examination, functional status measure (Medical Outcomes Study 36-item Short Form Health Survey [SF-36]), mood state assessment (Pr ofile of Mood States), neurocognitive tests, and serologic examination. Results: The prevalence of Lyme disease among adults on Nantucket Island wa s estimated to be 14.3% (95% CI, 9.3% to 19.1%). In multivariate analyses, persons with previous Lyme disease (mean time from infection to study evalu ation, 6.0 years) had more joint pain (odds ratio for having joint pain in any joint, 2.1 [CI, 1.2 to 3.5]; P = 0.007), more symptoms of memory impair ment (odds ratio for having any memory problem, 1.9 [CI, 1.1 to 3.5]; P = 0 .003), and poorer functional status due to pain (odds ratio for 1 point on the SF-36 scale, 1.02 [CI, 1.01 to 1.03]; P < 0.001) than persons without p revious Lyme disease. However, on physical examination, case-patients and c ontrols did not differ in musculoskeletal abnormalities, neurologic abnorma lities, or neurocognitive performance. Persons with previous Lyme disease w ho had persistent symptoms after receiving treatment (n = 67) were more lik ely than those who had completely recovered to have had fever, headache, ph otosensitivity, or neck stiffness during their acute illness (87% compared with 13%; odds ratio, 2.4 [CI, 1.0 to 5.5]; P = 0.045); however, the perfor mance of the two groups on neurocognitive tests did not significantly diffe r. Conclusions: Because persons with previous Lyme disease exhibited no sequel ae on physical examination and neurocognitive tests a mean of 6.0 years aft er infection, musculoskeletal and neurocognitive outcomes seem to be favora ble. However, long-term impairment of functional status can occur.