Only 18% of Lyme Disease patients studied in Nova Scotia had a rash… not the 60-80% stated by Canadian governments, AMMI, and in Canadian medical curricula

Lyme Arthritis: an Emerging Clinical Problem in Nova Scotia, Canada

Pier D. Glaude1, Adam M. Huber1, Timothy Mailman2, Suzanne Ramsey2, Bianca Lang2 and Elizabeth Stringer1

Article first published online: 27 MAR 2014

DOI: 10.1002/art.38498

Seventeen patients were identified; all patients were referred for evaluation of arthritis. 76% of patients presented in 2012 and 2013. Median age was 11.5 years (2.6–15.8), 16 were male. All lived in known endemic areas with Lunenburg county being most common (59%); 76% did not recall a tick bite. Subjects were referred by their family physician (7), emergency department (4), orthopedic surgery (4), and infectious diseases (2). The median number of physician visits for MSK symptoms prior to rheumatology consult was 2 (range 1 to >5). Only one patient was referred with a known diagnosis of LD; LD was suspected in 37.5% of the remaining cases based on referral information. Six patients had prior joint aspiration, 2 of whom were treated for septic arthritis. Pain and/or swelling were reported by all patients; in those with swelling 47% were persistent/53% episodic. The median number of joints involved was 1, with 94% having knee involvement. Patients reported MSK–symptoms for a median of 2 months (range 0.1–11) prior to referral to rheumatology. Four patients had a history of neurologic manifestations of LD prior to MSK presentation, none of which were recognized as LD. ECG was done in 13 cases and was normal. Three patients had a history of erythema migrans. 14/17 patients have completed antibiotic treatment. Arthritis resolved in 50% of patients after 1 course of antibiotics and 29% after 2 courses. A third course of antibiotics was required in 21% of patients for persistent arthritis. Two patients continued to have arthritis following completion of antibiotic therapy. At a median of 5 months (range 0–50) following treatment, there are 2 patients with persistent synovitis and functional limitations; one having evidence of joint damage despite extensive arthritis treatment (NSAID, steroid injection, DMARDs and a biologic).

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  • Carol Fennell says:

    This is what I have now. I have been sick since 2002. I have neck stiffness and soreness, as well as swelling,stiffness and soreness in the.jaw(left),knee(left).
    I also have a sore throat(muscles). I am from Lunenburg

  • Rudolf W Mueller says:

    How can any one talk about % in a group of 17 patients ? This is an alarmist paper that has nothing to do with real epidemiology as is implied. We need to know how prevalent the infection is and how many people are exposed to Borellia before drawing conclusions on the disease spread. This is a report on observations , not a study. I hope that now there will be province wide random testing for Lyme disease to get true information on how wide spread the exposure is. The the myth that people have to see specific doctors to have the disease “diagnosed”, doctors who blame every chronic aliment on Lyme is created by continued uncertainty and lack of reliable information.

    • Canlyme says:

      We can’t and shouldn’t ignore findings, and certainly not then refer to them as alarmist, that is simply a strange comment that we often hear from medical officials who use it as an excuse not to publish information that can save lives. We can talk about it because it has been reported. That was an important bit of information that should be pointed out so that in future studies, we can further investigate. That percentage certainly seems important to us at CanLyme considering we talk to thousands each year, and is completely in line with what we see. That bit of information is in line with the most current research as well that indicates only a small subset of Borrelia will cause a rash, and that of the rashes that do occur only 9 % take the over-hyped, over-expected (by physicians) “bull’s eye” form.

    • David Cubberley says:

      Rudolf Mueller, you seem more offended to learn that only three of seventeen people had a bullseye rash than you are by the claim that 80% of people with Lyme get a bullseye rash, and therefore if you didn’t get one, you don’t have lyme – that thinking is prevalent, misleading, and in a doctor’s mind is a basis for denying diagnosis. Yet that doesn’t concern you? Here in BC few ever get a bullseye rash – yet have borreliosis and get rid of it when diagnosed clinically and treated appropriately.

      • marshall desveaux says:

        Rudolf, You obviously don’t have to live with the disease.YOU HAVEN’T GOT A CLUE ABOUT THE TOPIC OF LYME.

  • jill Smith says:

    Is Canada doing anything to develop a Lyme vaccine?