Center for Immunology and Inflammatory Diseases, Department of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Infect Dis. 2024 Aug 14;230(Supplement_1):S1-S10. doi: 10.1093/infdis/jiae126.
Lyme arthritis (LA) was recognized as a separate entity in 1975 because of geographic clustering of children often diagnosed with juvenile rheumatoid arthritis in Lyme, Connecticut. After identification of erythema migrans as a common early feature of the illness, a prospective study of such patients implicated Ixodes scapularis ticks in disease transmission. In 1982, the causative agent, now called Borrelia burgdorferi, was cultured from these ticks and from Lyme disease patients. Subsequently, it was shown that LA could usually be treated successfully with oral antibiotics but sometimes required intravenous antibiotics. Yet, a small percentage of patients developed a dysregulated, proinflammatory immune response leading to persistent postinfectious synovitis with vascular damage, cytotoxic and autoimmune responses, and fibroblast proliferation, a lesion similar to that of rheumatoid arthritis. The message from postinfectious LA for other autoimmune arthritides is that a complex immune response with autoimmune features can begin with a microbial infection.
莱姆关节炎（LA）于 1975 年被确认为一种独立的疾病实体，因为在康涅狄格州莱姆，儿童常被误诊为幼年型类风湿关节炎，但存在地理聚集性。在识别出游走性红斑是这种疾病的一个常见早期特征后，对这些患者进行的前瞻性研究表明，扇头蜱与疾病传播有关。1982 年，从这些蜱虫和莱姆病患者中培养出了现在被称为伯氏疏螺旋体的病原体。随后表明，LA 通常可以通过口服抗生素成功治疗，但有时需要静脉注射抗生素。然而，一小部分患者会出现失调的、促炎免疫反应，导致持续性感染后滑膜炎，伴有血管损伤、细胞毒性和自身免疫反应以及成纤维细胞增殖，病变类似于类风湿关节炎。感染后莱姆关节炎对其他自身免疫性关节炎的启示是，具有自身免疫特征的复杂免疫反应可能始于微生物感染。
