The challenge for patients

The Netherlands Journal of Medicine has been shining an interesting light on attitudes to Lyme disease: now you see reason; now you don’t.

In March 2011 the Netherlands Journal of Medicine published a review (Tired of Lyme borreliosis. Coumou et al) which seemed intended to help Dutch physicians cope with the many people who believe they may have Lyme disease. The review says that in long lasting manifestations of Lyme disease the sensitivity of serology approaches 100% and that after adequate treatment there is no benefit of additional antibiotics.

In the same issue was an editorial (The challenge of Lyme disease: tired of the Lyme wars. Kullberg et al) This editorial points out that serological diagnosis of Lyme disease has its limitations and that the results from the Klempner trials cannot rule out the efficacy of longer term antibiotics. The authors state that

“Thus, there is a need for well-designed studies on this subject, rather than misusing outcomes of underpowered trials of disputed quality to either defend or deny the possible effect of antimicrobial therapy.”

The editorial also raised the issue of adequate treatment:

 “Indeed, if ‘adequate’ signifies that the microorganism has been eradicated and the immune system has come to rest, the problem has been solved, but the issue rather is whether treatment has been ‘adequate’ or not in patients who continue to feel ill.”

This editorial was very balanced and positive, however, some people couldn’t let it rest there. In the January 2012 edition, Klempner, Halperin, Baker, Shapiro, O’Connell, Fingerle and Wormser put their names to an editorial (Lyme borreliosis: the challenge of accuracy) in which they defend the Klempner trials and say that they

“did not find any evidence, based on over 700 samples from 129 patients that were examined by culture and polymerase chain reaction (PCR) assays, for persistent B. burgdorferi sensu stricto infection in patients with persistent symptoms after treatment for Lyme borreliosis.”

This was too much for LDA because the Klempner trials had specifically excluded any PCR positive cases, so however many samples they took from people included in the trials, they weren’t going to find B burgdorferi.

LDA’s chairman and medical director sent a letter to the journal which has been published in the April issue (Lyme disease – the challenge for patients. Huyshe-Shires & Pearson).

All the articles are freely available on the Netherlands Journal of Medicine website.