A "minority" opinion about the diagnosis and treatment of Lyme arthritis.

Historically, arthritis was the main symptom which led to the description of the disease called Lyme borreliosis. However, a relatively high awareness of doctors and patients of tick-borne diseases seems to cause a trend to frequently diagnose this antibiotic-sensitive disease. A case can be defined as borreliosis only if either the typical erythema migrans is reliably identified by a physician or if a characteristic late manifestation of Lyme disease is accompanied by unequivocal serological and/or bacteriological evidence of Borrelia infection. Within the musculoskeletal system, the only reliably characteristic symptom is true synovitis, as defined by the palpable swelling of a joint. Mere joint pain or the subjective pain syndrome of fibromyalgia do not constitute a defining symptom for borreliosis. An evaluation of the frequency of Borrelia-associated arthritis in our Viennese rheumatology outpatient clinic revealed only six well-defined cases among 1,673 subsequent referrals. Based on "serological" suspicion, the question had been asked about possible borreliosis in 87 of these patients. In order to avoid unnecessary anxiety about possible long-term complications of Lyme disease among (actually misdiagnosed) patients, the diagnosis of Lyme arthritis should only be made according to the stringent criteria mentioned above. The antibiotic treatment, which is given to many questionable cases of borreliosis ex iuvantibus, although possibly of benefit to a few cases of otherwise undiagnosed reactive arthritis due to infections with microbes other than Borrelia burgdorferi, has to be termed irrational.