PCR 阳性莱姆关节炎患者的治疗特征和临床结局：全国性队列研究。

Characteristics and clinical outcomes after treatment of a national cohort of PCR-positive Lyme arthritis.

机构信息

EA 7290-Virulence bactérienne précoce, groupe borréliose de Lyme, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.

Service de Rhumatologie, CHU de Bordeaux, France.

出版信息

Semin Arthritis Rheum. 2019 Jun;48(6):1105-1112. doi: 10.1016/j.semarthrit.2018.09.007. Epub 2018 Sep 28.

DOI:10.1016/j.semarthrit.2018.09.007

PMID:30344080

Abstract

OBJECTIVES

To describe the clinical and microbiological characteristics and outcomes after antibiotic treatment of a national cohort of patients with Lyme arthritis confirmed by PCR testing on synovial fluid and by serology, when available.

METHODS

Using the French National Reference Center for Borrelia database, patients with a positive PCR on synovial fluid for Borrelia were identified. Patient clinical and biological characteristics were reviewed from patient records. Long-term outcomes after treatment were studied through a questionnaire and with follow-up data.

RESULTS

Among 357 synovial fluid testing by PCR between 2010 and 2016, 37 (10.4%) were positive for Borrelia. Patients' median age was 36 years (range 6-78) with 61% of men and 28% patients under 18. The presentation was monoarticular in 92% and the knee was involved in 97%. Contrary to the Borrelia species repartition in European ticks, B. burgdorferi sensu stricto was the most prevalent species found in synovial fluid (54%) followed by B. azfelii (29%) and B. garinii (17%). Antibiotic treatments were mainly composed of doxycycline (n = 24), ceftriaxone (n = 10) and amoxicillin (n = 6), for a median duration of 4 weeks (range 3-12). Despite a properly conducted treatment, 34% of patients (n = 12) developed persistent synovitis for at least 2 months (median duration 3 months, range 2-16). Among those, 3 developed systemic inflammatory oligo- or polyarthritis in previously unaffected joints with no signs of persistent infection (repeated PCR testing negative), which mandated Disease-Modifying Antirheumatic Drugs (DMARD) introduction, leading to remission.

CONCLUSION

In France and contrary to ticks ecology, Lyme arthritis is mainly caused by B. burgdorferi sensu stricto. Despite proper antibiotic therapy, roughly one third of patients may present persistent inflammatory synovitis and a small proportion may develop systemic arthritis. In such cases, complete remission can be reached using DMARD.

摘要

目的

通过聚合酶链反应（PCR）检测滑液和血清（如果可行），对确诊为莱姆关节炎的患者进行临床和微生物学特征描述以及抗生素治疗后结局的分析。

方法

利用法国国家伯氏疏螺旋体参考中心数据库，我们确定了滑液 PCR 检测为伯氏疏螺旋体阳性的患者。从患者病历中回顾了患者的临床和生物学特征。通过问卷调查和随访数据来研究治疗后的长期结局。

结果

在 2010 年至 2016 年期间进行的 357 次滑液 PCR 检测中，有 37 次（10.4%）为伯氏疏螺旋体阳性。患者的中位年龄为 36 岁（范围 6-78 岁），61%为男性，28%为 18 岁以下。92%的患者表现为单关节炎，97%累及膝关节。与欧洲蜱虫中伯氏疏螺旋体的物种分布相反，B. burgdorferi sensu stricto 是在滑液中发现的最常见的物种（54%），其次是 B. azfelii（29%）和 B. garinii（17%）。抗生素治疗主要包括多西环素（n=24）、头孢曲松（n=10）和阿莫西林（n=6），疗程中位数为 4 周（范围 3-12 周）。尽管进行了适当的治疗，但仍有 34%的患者（n=12）出现至少 2 个月（中位数持续时间 3 个月，范围 2-16 个月）的持续性滑膜炎。其中，3 名患者在先前未受累的关节中出现了全身性炎症性寡关节炎或多关节炎，且无持续性感染迹象（重复 PCR 检测阴性），需要使用疾病修饰抗风湿药物（DMARD），从而达到缓解。