Musculoskeletal and neurologic outcomes in patients with previously treated Lyme disease

Ann Intern Med. 1999 Dec 21;131(12):919-26. doi: 10.7326/0003-4819-131-12-199912210-00003.


Background: Previous follow-up studies of patients with Lyme disease suggest that disseminated infection may be associated with long-term neurologic and musculoskeletal morbidity.

Objective: To determine clinical and functional outcomes in persons who were 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 (Profile of Mood States), neurocognitive tests, and serologic examination.

Results: The prevalence of Lyme disease among adults on Nantucket Island was 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 evaluation, 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 impairment (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 previous Lyme disease. However, on physical examination, case-patients and controls did not differ in musculoskeletal abnormalities, neurologic abnormalities, or neurocognitive performance. Persons with previous Lyme disease who had persistent symptoms after receiving treatment (n = 67) were more likely than those who had completely recovered to have had fever, headache, photosensitivity, 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 performance of the two groups on neurocognitive tests did not significantly differ.

Conclusions: Because persons with previous Lyme disease exhibited no sequelae on physical examination and neurocognitive tests a mean of 6.0 years after infection, musculoskeletal and neurocognitive outcomes seem to be favorable. However, long-term impairment of functional status can occur.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Arthralgia / etiology
  • Fatigue / etiology
  • Female
  • Follow-Up Studies
  • Humans
  • Lyme Disease / classification
  • Lyme Disease / complications*
  • Lyme Disease / epidemiology
  • Male
  • Massachusetts / epidemiology
  • Memory Disorders / etiology
  • Middle Aged
  • Multivariate Analysis
  • Musculoskeletal Diseases / etiology*
  • Nervous System Diseases / etiology*
  • Outcome Assessment, Health Care*
  • Prevalence
  • Retrospective Studies