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| Caractéristiques clinicobiologiques et évolution après traitement des arthrites de Lyme dans la région Ouest de la France : étude multicentrique rétrospective de 52 patients (Clinical, biological characteristics and evolutionafter treatment of Lyme arthritis in the West region of France: a multicentric retrospective study of 52 patients) | ||
Corre, Clémence - (2019-10-25) / Universite de Rennes 1 - Caractéristiques clinicobiologiques et évolution après traitement des arthrites de Lyme dans la région Ouest de la France : étude multicentrique rétrospective de 52 patients Langue : Anglais Directeur de thèse: Coiffier, Guillaume Thématique : Médecine et santé | ||
Mots-clés : Arthrite de lyme, diagnostic, évolution, infiltration de corticoïdes, Lyme, Maladie de , Injections, Corticothérapie, Rémission (médecine) Résumé : 1 résumé en anglais Résumé (anglais) : Objective: To describe clinical and biological characteristics of patients affected by Lyme arthritis and undergoing evolution after antibiotic treatment in west region of France. Methods: Observational retrospective multicentric study in western France of Lyme arthritis defined by a clinical acute or chronic peripheral arthritis on native joint with a positive Borrelia burgdorferi serological testing confirmed by western blot, and/or the positivity of Borrelia PCR in the synovial fluid, and no other aetiology of arthritis. Results: 52 patients were included, with a mean age of 43 years old (± 19.4), including 29 men (55.8%) and 9 children (17.3%). The median delay between arthritis and Lyme disease diagnosis was 5 months (1.5-8). Lyme arthritis was a monoarthritis (82.7%), involving the knee (98.1%). The mean range of the CRP was 50.6 ± 53.4 mg/l. Median of synovial white blood cells count was 16000/mm3 (9230-40500). Lyme serological testing was always positive in IgG and more than 1/3 of them were positive in IgM. Borrelia PCR was positive in the synovial fluid or synovial biopsy in 16 cases (39%), with specie identification in 13 cases: B. sensu stricto (n=5), B. afzelii (n=3) and B. garinii (n=5). Every patient received antibiotics, mainly Doxycycline (84.6%) with a mean duration of 28 days. Out of the 47 followed patients, 35 (75%) were cured. A relapse was observed for 6 (17.1%) patients after a first line of antibiotics. GIAI associated with the first line of antibiotics was statistically associated with recovery (100% vs 66.7%, p=0.03), without more significant relapse (18.2% vs 16%, p=0.91). Conclusion: In our western France cohort, Lyme arthritis was presenting as a chronic monoarthritis of the knee. Synovial PCR testing only is not sensitive enough for diagnosis (39%), which requires a positive Lyme serological testing in the serum including an ELISA test confirmed by a positive Western Blot. All the 3 pathogenic species of Borreliella in Europe can be responsible of Lyme arthritis. Evolution after first line antibiotics showed 75% recovery. For the first time, we reported a higher rate of recovery when GIAI were associated with first-line antibiotic therapy without more relapse compared with antibiotics alone. Identifiant : rennes1-ori-wf-1-13007 | ||
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