• N A Shadick, C B Phillips, E L Logigian, A C Steere, R F Kaplan, V P Berardi, P H Duray, M G Larson, E A Wright, K S Ginsburg, J N Katz, and M H Liang.
• Department of Rheumatology-Immunology, Brigham & Women's Hospital, Boston, MA 02115.
• Ann. Intern. Med. 1994 Oct 15; 121 (8): 560-7.

ObjectiveTo ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.DesignPopulation-based, retrospective cohort study.SettingA coastal region endemic for Lyme disease.ParticipantsPatients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.MeasurementsA standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.ResultsCompared with the control group (n = 43), the Lyme group (n = 38; mean duration from disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment [n = 4], and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).ConclusionsPersons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.

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