How Should Clinicians Manage Patients with “Chronic Lyme Disease?”

Richard Krieger, MD, chairman of the Infection Control Committee at Chilton Medical Center, and infectious disease physician at ID care, explains how clinicians should manage patients with so-called “chronic Lyme disease.”

Interview Transcript (slightly modified for readability)

“[We’re talking about] managing patients with chronic symptoms and the diagnosis of Lyme disease. First of all, there are really two schools of thought; there are the people who say there’s such a thing as chronic Lyme disease and you need to treat it long-term, and then there’s the people who are right, who say there is no such thing.

One of the problems is that there is a condition that is more properly called post-Lyme syndrome. People who have truly been infected with Lyme disease, have been treated appropriately, may not feel 100% better, they may have a chronic fatigue type of illness. Some people may even have, if you’re familiar with fibromyalgia, a condition that causes achiness and pain and [there are] no specific positive tests and there’s nothing that can be done to diagnose this; it’s a physical exam diagnosis and a history diagnosis. Fibromyalgia is fairly common in the population to begin with, and it does appear that certain things like Lyme disease may be able to set it off in some people. There are people who will get over a course of Lyme disease and have a fibromyalgia type of illness, which is mislabeled [as] chronic Lyme disease.

There are certain people in the past who said that treating someone like that with antibiotics long-term would make them feel better and that they seemed to do better while they were on the antibiotics; I think that has more or less been debunked. It’s felt that a large part of that was probably the placebo effect. People were getting these strong antibiotics, so [they were thinking] ‘it must do some good, so yes, I feel better,’ but that’s probably not the case.

Really, once somebody’s treated for a full course, which is usually 4 weeks at most, for Lyme disease, if they continue to have these kinds of nonspecific fibromyalgia chronic fatigue-type symptoms, then they need to be treated symptomatically and not with antibiotics.

There’s one other chronic condition that can be seen, there [is] a rare group of people (and some people think that it might even be genetic) that [will] get Lyme arthritis from the infection [and] it will set off an immune reaction in the joint that will continue even after you take away the infection. Maybe it’s a poor analogy, but it’s like if you light a match and set fire to a newspaper, then you blow the match out, the match is gone, but the fire is continuing to burn. What probably happens is the Lyme disease probably sets off this reaction in the joint, which then continues, even after the infection is gone; that’s not the rule, that’s the exception, but it does happen in some people. In those people, it’s felt that in a course of usually months to years, [the arthritis] will burn itself out, but in the interim it’s treated the way any other arthritis is treated, with anti-inflammatory drugs and that type of thing.”