Sound thinking in the Netherlands

The editorial of the March 2011 edition of the Netherlands Journal of Medicine(1) gives a hint of an enlightened, scientific approach in the Netherlands revised guidelines due to be published later this year.

These guidelines have been developed “according to the recommendations for evidence-based development of guidelines by a multidisciplinary committee, including the National Society for Lyme Patients (NVLP)”. We have to wait for publication, but it is clear that these guidelines are going to acknowledge the inadequacy of evidence for appropriate treatment of anything but early Lyme disease. What is more, instead of just stating the thin evidence base, as the EFNS guidelines(2) also do, these 2011 revisions will take the unusual step of making recommendations on the approach to the patient with continuing symptoms.

The editorial points out that in other diseases there are acknowledged failures of treatment and late recurrences. The authors say

“There is general agreement that such patients deserve medical evaluation to rule out a potential relapse when having persistent or recurrent symptoms, and the approach to infection with B. burgdorferi should not be different. There is no place for circular reasoning (‘Your treatment has been “adequate”, so you can’t have symptoms’) or exaggerated assumptions (‘standard therapy never fails’, or ‘our serological assay is 100% sensitive’).”

We await publication of the revised guidelines with interest.

1) Kullberg, B J, A Berende, and J W M van der Meer. 2011. The challenge of Lyme disease: tired of the Lyme wars. The Netherlands Journal of Medicine 69, no. 3 (March): 98-100. http://www.ncbi.nlm.nih.gov/pubmed/21444933

2) Mygland, a, U Ljøstad, V Fingerle, T Rupprecht, E Schmutzhard, and I Steiner. 2010. EFNS guidelines on the diagnosis and management of European Lyme neuroborreliosis. European journal of neurology : the official journal of the European Federation of Neurological Societies 17, no. 1 (January): 8-16, e1-4. http://www.ncbi.nlm.nih.gov/pubmed/19930447