Chronic Lyme disease

Not to be confused with Neuroborreliosis or Post-treatment Lyme disease syndrome.
Chronic Lyme disease
Pseudomedical diagnosis
RisksNocebo
Treatment risksDangers of long-term antibiotic therapy, delaying appropriate care[1]
LegalitySome jurisdictions have legislated to protect doctors offering worthless and potentially dangerous treatments
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Chronic Lyme disease (CLD) is the name used by some people with non-specific symptoms, such as fatigue, muscle pain, and cognitive dysfunction to refer to their condition, even if there is no evidence that they had Lyme disease.[2][3] Both the label and the belief that these people's symptoms are caused by this particular infection are generally rejected by medical professionals.[2] Chronic Lyme disease is distinct from post-treatment Lyme disease syndrome, a set of lingering symptoms which may persist after successful antibiotic treatment of infection with Lyme-causing Borrelia bacteria, and which may have similar symptoms to those associated with CLD.[3]

Despite numerous studies, there is no evidence that symptoms associated with CLD are caused by any persistent infection.[4] The symptoms attributed to chronic Lyme are in many cases likely due to fibromyalgia or chronic fatigue syndrome.[5][6] Fibromyalgia can be triggered by an infection, and antibiotics are not a safe or effective treatment for post-infectious fibromyalgia.[7] Fatigue, joint and muscle pain are also experienced by a minority of people following antibiotic treatment for Lyme disease.[3]

A number of alternative health products are promoted for chronic Lyme disease,[8] of which possibly the most controversial and harmful is long-term antibiotic therapy, particularly intravenous antibiotics.[9][10] Recognised authorities advise against long-term antibiotic treatment for Lyme disease, even where some symptoms persist post-treatment.[11][12][13]

In the United States, after disciplinary proceedings by state medical licensing boards, a subculture of "Lyme literate" physicians has successfully lobbied for specific legal protections, exempting them from the standard of care and science-based treatment guidelines. Such legislation has been criticised as an example of "legislative alchemy", the process whereby pseudomedicine is legislated into practice.[14][15][16] Some doctors view the promotion of chronic Lyme disease as an example of health fraud.[17]

  1. ^ Auwaerter, PG; Melia, MT (2012). "Bullying Borrelia: when the culture of science is under attack". Transactions of the American Clinical and Climatological Association. 123: 79–89, discussion 89-90. PMC 3540629. PMID 23303970.
  2. ^ a b Cite error: The named reference nejm-feder was invoked but never defined (see the help page).
  3. ^ a b c Wong, Katelyn H.; Shapiro, Eugene D.; Soffer, Gary K. (February 2022). "A Review of Post-treatment Lyme Disease Syndrome and Chronic Lyme Disease for the Practicing Immunologist". Clinical Reviews in Allergy & Immunology. 62 (1): 264–271. doi:10.1007/s12016-021-08906-w. ISSN 1080-0549. PMID 34687445. S2CID 239461094. In some cases, some of the subjective symptoms such as fatigue, myalgia, or arthralgia can persist following antibiotic therapy
  4. ^ Baker, P. J. (14 July 2010). "Chronic Lyme disease: in defense of the scientific enterprise". The FASEB Journal. 24 (11): 4175–77. doi:10.1096/fj.10-167247. PMID 20631327. S2CID 36141950.
  5. ^ Cite error: The named reference FMWars was invoked but never defined (see the help page).
  6. ^ Hall, Harriet (2013-09-03). "Does Everybody Have Chronic Lyme Disease? Does Anyone?". Science Based Medicine.
  7. ^ Ranque-Garnier, S.; Eldin, C.; Sault, C.; Raoult, D.; Donnet, A. (March 2019). "Management of patients presenting with generalized musculoskeletal pain and a suspicion of Lyme disease" (PDF). Médecine et Maladies Infectieuses. 49 (2): 157–66. doi:10.1016/j.medmal.2019.01.008. ISSN 1769-6690. PMID 30765287. S2CID 73420955.
  8. ^ McSweegan, Edward (28 June 2017). "Lyme Disease: Questionable Diagnosis and Treatment". Quackwatch.
  9. ^ Lantos PM (June 2015). "Chronic Lyme disease". Infect. Dis. Clin. North Am. (Review). 29 (2): 325–40. doi:10.1016/j.idc.2015.02.006. PMC 4477530. PMID 25999227.
  10. ^ Salzberg, Steven (2016-04-04). "Long-Term Antibiotic Use For Lyme Disease Doesn't Work, Study Finds". Forbes.
  11. ^ Cite error: The named reference idsa guideline was invoked but never defined (see the help page).
  12. ^ Cite error: The named reference pmid17522387 was invoked but never defined (see the help page).
  13. ^ Cite error: The named reference nih-cld was invoked but never defined (see the help page).
  14. ^ Bellamy, Jann (2014-05-15). "Legislative Alchemy 2014 (so far)". Science Based Medicine.
  15. ^ Mason DJ, Leavitt JK, Chaffee MW (2014). Policy & Politics in Nursing and Health Care. Elsevier Health Sciences. pp. 310–11. ISBN 978-0323316064.
  16. ^ Warner, Susan (2007-02-07). "State official subpoenas infectious disease group". The Scientist.
  17. ^ Cite error: The named reference ct was invoked but never defined (see the help page).