Lyme Arthritis Program

A Pioneer in Lyme Disease

Our program is led by Allen Steere, MD, one of the world's foremost experts on Lyme disease. Dr. Steere discovered the illness in 1976 and laid the foundation for understanding the many manifestations of the disease, including Lyme arthritis (a late-stage manifestation of Lyme disease).

Today, Dr. Steere is researching why some patients with Lyme arthritis have persistent joint inflammation after using antibiotic therapy to eliminate the Lyme disease bacterium. This research is leading to improved diagnostic and treatment capabilities for such patients.

What to Expect

Prior to your first appointment, one of our rheumatologists will review your records, particularly previous Lyme testing. Based on this evaluation, you will either be scheduled for a formal appointment, or referred to one of our colleagues in Neurology, Infectious Disease, or another appropriate specialist for the best care available for your specific case.

At your first appointment, one of our rheumatologists will review your history, perform a physical examination and decide which tests are necessary for diagnostic purposes.

Many symptoms of Lyme disease can be seen in other conditions. Our physicians' experience with Lyme disease—and the diagnostic tests we have developed—help us recognize that infection or differentiate it from other diseases, and if Lyme disease, determine what stage it is in. We treat patients according to the Infectious Disease Society of America guidelines.

Most patients with Lyme disease respond well to a three-to-four-week course of oral antibiotics (e.g. doxycycline or amoxicillin). Patients who do not have symptoms early in the infection or are not treated for early-stage Lyme disease may develop organ-system involvement of the infection.

Some patients who develop Lyme arthritis may require antibiotic therapy delivered intravenously. In these cases, a peripherally inserted central catheter (PICC line) will be placed in your arm and the initial infusion administered in the Rheumatology Unit's Infusion Center. Our experience in coordinating home infusion care will probably allow you to receive the remaining course of antibiotics in the comfort of your home rather than in the hospital.

In a small percentage of cases, Lyme arthritis persists after oral and intravenous antibiotics have apparently eliminated the bacterium. This complication is thought to result from the development of autoimmunity in affected joints. After appropriate antibiotic therapy, we treat these patients with anti-inflammatory medications or disease-modifying antirheumatic drugs.

Mass General's Multidisciplinary Approach

Multidisciplinary collaboration, a major strength at Mass General, is crucial in caring for patients with organ-system involvement of Lyme disease, particularly if there is neurologic or heart involvement. Whenever necessary, we involve other world-class specialists at the hospital to manage the various complications of the illness.

About this Program

Treating Lyme Disease, Primarily Lyme Arthritis

Lyme disease, a multistage bacterial infection, is caused by a spiral-shaped bacterium transmitted by a tick bite. The condition has a wide range of signs and symptoms that can affect many different body parts, particularly the skin, joints, nervous system or heart. Tests are required to diagnose Lyme disease by detecting the presence of a specific antibody or in some cases, the organism itself.

In most cases, we can effectively treat early-stage Lyme disease with a three-to-four-week course of oral antibiotics. However, if early-stage Lyme disease is asymptomatic or goes untreated, the patient may develop late-stage complications, most commonly Lyme arthritis.

Our program is highly skilled in treating Lyme arthritis and the many other manifestations of Lyme disease across all disease stages. We generally refer patients younger than 12 years of age to the pediatric rheumatologists at the Mass General for Children.

Leadership in Lyme Disease

Program director Allen Steere, MD, who discovered Lyme disease in 1976, also directed studies of a vaccine for the condition that was available from 1998 to 2002. He has won numerous awards for his work in Lyme disease over the past 30+ years.

Since coming to Mass General in 2002, Dr. Steere has directed our research and clinical efforts in Lyme disease. He works with all the physicians in the Rheumatology Unit and throughout the hospital to provide patients with state-of-the-art diagnostic and treatment services.

Promising Research into Lyme Arthritis

Dr. Steere's laboratory performs translational studies using samples from patients with Lyme arthritis or rheumatoid arthritis (two conditions with many similarities) to:

• Identify autoantigens that lead to the immune response that may cause antibiotic-refractory Lyme arthritis or rheumatoid arthritis
• Identify biomarkers (biological features) in both diseases that will help us determine disease stage and aggressiveness of treatment
• Develop better diagnostic tests for Lyme disease (in conjunction with the Mass General Microbiology Laboratory)

We are hopeful these research efforts will enhance our diagnostic and treatment capabilities, and lead to better patient outcomes.