The Fibromyalgia Impact Questionnaire: a useful tool in evaluating patients with post-Lyme disease syndrome.

OBJECTIVE: To determine the reliability and validity of a modified version of the Fibromyalgia Impact Questionnaire (FIQ) in evaluating patients with post-Lyme disease syndrome (PLDS). METHODS: In this cross-sectional analysis 13 PLDS, 18 fibromyalgia (FM), and 16 healthy controls (n = 47) completed a modified FIQ containing items to evaluate physical impairment, symptom severity, and global well-being. Comparisons between groups were done using analysis of variance with a significance level set at 0.05. RESULTS: PLDS patients demonstrated statistically significantly greater levels of impairment than controls in physical functioning, FIQ total score, global well-being, joint pain, fatigue, depression, ability to perform activities of daily living, and memory/concentration. FM patients demonstrated a statistically significantly greater level of impairment than the control group in all categories, and the scores were significantly higher than the PLDS group in the measurement of physical impairment, FIQ total score, muscle pain, and joint pain. Overall, the instrument possesses good reliability and validity, although adequacy of this instrument to measure impairment in the male PLDS population needs further elucidation. CONCLUSION: The results of this study suggest that the modified FIQ may be a useful tool in evaluating PLDS patients. The findings suggest that there may be some differences in the etiopathology of the symptoms experienced by PLDS and FM patients.

Clinical and neurocognitive features of the post Lyme syndrome.

OBJECTIVE: To evaluate neurocognitive impairment in patients with persistent arthralgia, fatigue, and subjective memory loss in patients after Lyme disease (post-Lyme syndrome, PLS). METHODS: We compared the clinical, neurocognitive, and psychological features of 23 patients with PLS to 23 age, sex, and education matched recovered patients (REC). All met Centers for Disease Control criteria for Lyme disease, were ELISA positive at onset of Lyme disease and were previously treated with standard antibiotic regimens. RESULTS: Of the patients with PLS, 7 (30%) had fibromyalgia (FM), 3 (13%) had chronic fatigue syndrome, and 10 (43%) had similar but milder symptoms but did not meet the criteria for either. 22 of 23 patients with PLS complained of decreased memory or concentration problems. Patients with PLS had significantly lower scores on the attention/concentration scale (p = 0.012) of the Wechsler Memory Scale-Revised (WMS-R), indicating lowered attention/concentration. 52% of patients with PLS and 35% in the REC group had significantly lower (p < 0.05) WMS-R verbal memory scores than visual memory scores. The PLS group had subjectively more problems with sleep and mood changes and higher scores on several scales of Symptom Check List 90-R (p < 0.01), indicating greater physical distress. Beck Depression Inventory scores were also higher for the PLS than the REC group (p < 0.005), but were within the normal range. CONCLUSION: Despite antibiotic treatment, a sequelae of Lyme disease may be a PLS characterized by persistent arthralgia, fatigue, and neurocognitive impairment that is probably induced by Lyme disease.

Lyme disease: an infectious and postinfectious syndrome.

OBJECTIVE: To determine chronic morbidity and the variables that influence recovery in patients who had been treated for Lyme disease. METHODS: Retrospective evaluation of 215 patients from Westchester County, NY, who fulfilled Centers for Disease Control case definition for Lyme disease, were anti-Borrelia antibody positive and were diagnosed and treated at least one year before our examination. RESULTS: Erythema migrans had occurred in 70% of patients, neurological involvement in 29%, objective cardiac problems in 6%, arthralgia in 78% and arthritis in 41%. Patients were seen at a mean of 3.2 years after initial treatment. A history of relapse with major organ involvement had occurred in 28% and a history of reinfection in 18%. Anti-Borrelia antibodies, initially present in all patients, were still positive in 32%. At followup, 82 (38%) patients were asymptomatic and clinically active Lyme disease was found in 19 (9%). Persistent symptoms of arthralgia, arthritis, cardiac or neurologic involvement with or without fatigue were present in 114 (53%) patients. Persistent symptoms correlated with a history of major organ involvement or relapse but not the continued presence of anti-Borrelial antibodies. Thirty-five of the 114 (31%) patients with persistent symptoms had predominantly arthralgia and fatigue. Antibiotic treatment within 4 weeks of disease onset was more likely to result in complete recovery. Children did not significantly differ from adults in disease manifestations or in the frequency of relapse, reinfection or complete recovery. CONCLUSION: Despite recognition and treatment, Lyme disease is associated with significant infectious and postinfectious sequelae.