Steere A C
Division of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Am J Med. 1995 Apr 24;98(4A):44S-48S; discussion 48S-51S. doi: 10.1016/s0002-9343(99)80043-6.
Musculoskeletal involvement, particularly arthritis, is a common feature of Lyme disease. Early in the illness, patients may experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone in one or a few locations at a time, frequently lasting only hours or days in a given location. Weeks to months later, after the development of a marked cellular and humoral immune response to the spirochete, untreated patients often have intermittent or chronic monoarticular or oligoarticular arthritis-primarily in large joints, especially the knee-during a period of several years. The diagnosis of Lyme arthritis is usually based on the presence of this characteristic clinical picture, exposure in an endemic area, and an elevated immunoglobulin G antibody response to Borrelia burgdorferi. In addition, spirochetal DNA can often be detected in joint fluid by polymerase chain reaction. Lyme arthritis can usually be treated successfully with 1-month courses of oral doxycycline or amoxicillin or with 2- to 4-week courses of intravenous ceftriaxone. However, patients with certain genetic and immune markers may have persistent arthritis, despite treatment with oral or intravenous antibiotics. B. burgdorferi may occasionally trigger fibromyalgia, a chronic pain syndrome with diffuse joint and muscle symptoms. This syndrome does not appear to respond to antibiotic therapy.
肌肉骨骼受累，尤其是关节炎，是莱姆病的常见特征。在疾病早期，患者可能会在一个或几个部位的关节、滑囊、肌腱、肌肉或骨骼出现游走性肌肉骨骼疼痛，在某个特定部位通常仅持续数小时或数天。数周或数月后，在对螺旋体产生显著的细胞和体液免疫反应后，未经治疗的患者在数年期间常出现间歇性或慢性单关节或寡关节关节炎，主要累及大关节，尤其是膝关节。莱姆关节炎的诊断通常基于这种特征性临床表现、在流行地区的暴露史以及对伯氏疏螺旋体的免疫球蛋白G抗体反应升高。此外，通过聚合酶链反应通常可在关节液中检测到螺旋体DNA。莱姆关节炎通常可用为期1个月的口服多西环素或阿莫西林疗程或为期2至4周的静脉注射头孢曲松疗程成功治疗。然而，具有某些遗传和免疫标志物的患者，尽管接受了口服或静脉抗生素治疗，仍可能患有持续性关节炎。伯氏疏螺旋体偶尔可能引发纤维肌痛，这是一种伴有弥漫性关节和肌肉症状的慢性疼痛综合征。这种综合征似乎对抗生素治疗无反应。
