NIVELTULEHDUKSET YLEISIÄ MYÖS EUROOPASSA

[Bb]

Lähettäjä: Soijuv Lähetetty: 30.12.2004 11:00

Borrelioosissa esiintyy artikkelin mukaan Euroopassa usein erilaisia muutoksia nivelissä:


Joint manifestations of Lyme borreliosis in Europe. Herzer P
Scand J Infect Dis Suppl 1991;77:55-63
http://www.journals.uchicago.edu/JID/home.html
Department of Medicine, University of Munich, Germany.

Our clinical and serological studies have shown that Lyme arthritis is not a rare manifestation of Lyme borreliosis in Europe. The significance of serological findings for Lyme arthritis have more often remained uncertain in consideration of potential differential diagnoses than was to be expected on the basis of specificity controls. Various joint manifestations in the course of Lyme borreliosis have been distinguished. The succession or the coexistence of intermittent attacks of arthralgias and arthritis has been pointed out as particular indications of Lyme arthritis. We have noted diffuse hand and finger swelling as a striking feature of early Lyme arthritis.

Generally, Lyme arthritis has been attributable to Stage 3 of the disease. The most pathognomonic manifestation has been intermittent knee arthritis. The pattern of joint involvement has shown similarities to that in postenteric and postveneral reactive arthritides, in particular as regards the occurence of dactylitis (sausage digits) and heel involvement.

However, we have not seen sacroiliitis and Reiter's syndrome. As distinguished from typical Lyme arthritis, peculiar joint manifestations have been noted in association with acrodermatitis chronica atrophicans. Typing of Class I and II histocompatibility antigens did not give evidence of any immunogenetic basis for Lyme arthritis.

Unique ID: 92054276
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Unusual manifestations of Lyme borreliosis. A contribution to the clinical spectrum of this disease group
Detmar U, Maciejewski W, Link C, Breit R, Sigl H, Robl H, Preac-MursicV
Hautarzt 1989 Jul;40(7):423-9
Dermatologische und Allergologische Abteilung, St:aditischen Krankenhauses M:unchen-Schwabing.

Since the discovery that EM (erythema migrans), ACA (acrodermatitis chronica atrophicans) and BL (borrelial lymphocytoma) have an infectious etiology, these syndromes have been receiving particular attention. This report describes four patients whose dermatological symptoms did not at first indicate borreliosis. In all four cases serological antibody tests proved that they were caused by Borrelia burgdorferi. In two of these cases these findings were confirmed by bacterial cultures. The unusual skin symptoms, i.e. multiple disseminated erythema, erysipelas-like manifestations, swelling and discoloration of the eyelids and lichenoid papules, extend the known clinical spectrum of cutaneous borreliosis in Europe.

Language: Ger
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http://pages.prodigy.com/JRQR18A/index.htm
Dave Bartholomew

Acrodermatitis Chronica Atrophicans: a Late Manifestation of Lyme Disease -Synopsis by Dave Batholomew

The following is provided for information and is quoted from the article "Acrodermatitis Chronica Atrophicans: Historical and Clinical Overview," by Rudolph J. Scrimenti, Associate Clinical Professor of Dermatology, Medical College of Wisconsin, Milwaukee. Remarks added are in parenthesis.


Montgomery and Sullivan from the Mayo Clinic reviewed 45 cases of ACA in 1945, 39 of which occurred in immigrants. (The other six were born in the U.S.A. (DB))

(ACA has two stages): early infiltration and/or inflammation and, later atrophy.

ACA is an outstanding example of prolonged latency and chronic infection.

Early ACA usually begins in a subtle fashion with infiltration, inflammation, or doughy swelling of an extremity. Ordinarily mildly symptomatic, on rare occasions it may weep.

Patients do not usually associate it with an earlier bite. In some patients, it may be preceded by signs and symptoms of early LB. However, such information is not volunteered readily by patients because a correlation is often not perceived between symptoms separated by long time intervals.

Slow, but definite progression, over months to years, even decades, is the usual course. Central progression toward the torso ensues.

The face rarely is involved and may resemble dermatomyositis, contact dermatitis or collagen disease. The palms and soles participate in this disease process as they do in syphilis, but the lesions are much more confluent.

Eventually, atrophy appears in the involved sites, subcutaneous fat is lost, and inflammation may subside. Now the skin becomes wrinkled, thin, scaling, dry, hypohidrotic and transparent The underlying venous architecure is readily visible. Alopecia, hyperesthesia, hypo-and hyperpigmentation may occur. Atrophy also may involve nasopharyngeal, lingual, and vaginal mucous membranes. Various stages of inflammation and atrophy may coexist at the same time. A noteworthy feature of the atrophy is that it may take many years to occur and it is not an absolute requirement for the diagnosis. Also atrophy may be diffuse or localized. Rarely, sac-like formations occur in areas of macular atrophy. Superinfection of erythema migrans in patients with reexisting ACA has been reported in Europe.

Other special distinguishing features noted in European patients are fibrotic bands, fibrous juxta articular nodules, a distinctive arthropathy and pseudosclerodermoid skin changes.

Fibrous nodules appear painlessly over the elbows, knees, hands, fingers, and elsewhere. Ranging in size from one to three centimeters, they may be solitary, multiple and frequently grouped. Their color varies from yellow white to reddish blue.

European observers have reported a sclerosing process of connective tissue as an integral part of the syndrome of idiopathic atrophy. Such lesions vary from moderately infiltrated, yellow, stretched plaques of skin to firmly indurated marble white areas resembling scleroderma.

Deforming arthritis with bone atrophy associated with ACA was first reported in 1924 by Jesner.

Recent studies indicate subluxations, and luxations of small bones of the hands and feet are the most characteristic arthritic features.

A mild, but chronic, motor and/or sensory axonal polyneuropathy is characteristic in a large percentage of patients with chronic borreliosis on both sides of the Atlantic.

ASSOCIATED CONDITIONS . Enthesopathies, periostitis, myositis, myalgias, fasciitis, localized and generalized lymphadenopathy,weight loss fatigue, personality disorders usually with negative cerebrospinal fluid laboratory findings have been reported with ACA.

LABORATORY FINDINGS. Increased erythrocyte sedimentation rates are noted regularly. The organism can be cultured slowly on modified Barbour-Stoenner-Kelly medium from skin lesions, even decade-old lesions at temperatures of 32 to 33 C. Focal areas of plasma cells may be present in the deeper dermis. With progression, epidermal thinning, degeneration of elastic fibers and collagen occurs. Eventually after many years, advanced atrophy of the dermis, including all appendages, follows the inflammation. Later, the inflammation disappears, and a pronounced thinning of the entire dermis and subcutis develops. A rich mixture of plasma cells, if present may be the only feature ifferentiating sclerotic and atrophic ACA from idiopathic scleroderma (morphea) and lichen sclerosus, except for the presence of the spirochete. Immunohistologic staining shows a predominance of CD4 lymphocytes. Most, but not all, studies show no association between the development of ACA and HLA class II alleles.

Article source: Journal of Spirochetal and Tick-borne Diseases; Vol2, No4: 97-100. For reprints of the
article, address request to R.J. Scrimenti, MD, 3316 East Silver
Spring Dr., Suite 302, Milwaukee, WI 53217

Dr. Scrimenti diagnosed the first case of erythema migrans in the U.S. in
1975.
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Rheumatic manifestations related to acrodermatitis chronica atrophicans. A review of four cases.

Authors: Gerster JC, Peter O
Source: Rev Rhum Engl Ed 1998 Oct;65(10):567-70
Organization: Rheumatology and Rehabilitation Center, CHUV, Lausanne, Switzerland.


Abstract:

BACKGROUND: Acrodermatitis chronica atrophicans is a delayed manifestation of Lyme disease caused by a Borrelia burgdorferi subspecies, B. afzelii. Although rheumatic manifestations are rare, they can result in deformities of the fingers and toes if they are not treated promptly.

METHODS: We report four cases of acrodermatitis chronica atrophicans seen over a 15-year period.

RESULTS: Two patients had a noninflammatory unilateral knee effusion and one had swelling of the dorsum of one hand. Antimicrobial therapy was followed by a full recovery in the three patients who received an early diagnosis. The remaining patient, a 63-year-old woman, had swelling and dysesthesia in the fingers of both hands. She developed finger deformities over a period of two years. Although the swelling resolved under antimicrobial therapy, she had persistent reducible deformities of the fingers consistent with Jaccoud's arthropathy.

CONCLUSION: The diagnosis of acrodermatitis chronica atrophicans rests on a history of a tick bite, a suggestive skin biopsy histology and a positive Western blot for B. afzelii. A positive response to antimicrobial therapy is also required. Acrodermatitis chronica atrophicans, a common condition in central and northern Europe, can cause joint manifestations and persistent finger deformities in the absence of early treatment.