Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


A Prospective, Longitudinal Cohort Study Evaluating Psychosocial Risk and Protective Factors for Post Lyme Disease Syndrome.

Hassett6,  Afton L., Shlimbaum2,  Terry, Radvanski4,  Diane C., Herman1,  David J., Nahass1,  Ronald, Buyske3,  Steven, Sigal5,  Leonard H.

ID CARE
Phillips-Barber Family Health Center
Rutgers University
UMDNJ-Robert Wood Johnson Medical School, Union City, NJ
UMDNJ-Robert Wood Johnson Medical School
University of Michigan Medical School, Ann Arbor, MI

Background:

Rarely do patients manifest objective evidence of ongoing infection with B. burgdorferi after antibiotic treatment and yet it has been estimated that at least one third of treated Lyme disease patients report chronic pain, fatigue, and cognitive problems. The condition referred to as Post Lyme Disease Syndrome, may be more appropriately thought of as fibromyalgia triggered by an infectious disease. There is evidence that illness factors at baseline, such as symptom severity and functional status are associated with symptom persistence and functional status after treatment; however, little is known about psychosocial risk and protective factors.

Methods:

In a multicenter longitudinal study, 99 patients newly diagnosed with Lyme disease underwent comprehensive psychometric and medical/laboratory assessments at baseline. All patients received antibiotic treatment and at one year after diagnosis completed the Fibromyalgia Impact Questionnaire revised for Lyme disease (FIQ-LD) to evaluate the presence of chronic symptoms and functional status. Psychosocial factors assessed at baseline included: functional status (FIQ-LD), symptoms checklist, depression (PRIME-MD PHQ), catastrophizing (Coping Strategies Questionnaire-Catastrophizing subscale), negative affect and positive affect (Positive and Negative Affect Scale). At one year, patients with persistent symptoms ascribed to Lyme disease were compared to patients with resolved symptoms.

Results:

Of the 74 patients who completed the 1-year assessment, 24 (32.4%) reported chronic symptoms – predominantly pain (VAS mean PLDS: 3.38±2.63 vs. Recovered: 0.43±0.85) and fatigue (VAS mean PLDS: 5.98±1.83 vs. Recovered: 1.56±1.96). Compared with patients who reported no chronic symptoms at one year, only functional status (45.00±18.23 vs. 31.90±21.19, p<0.01) and positive affect (31.57±6.63 vs. 35.92±4.96, p<.003) at baseline differed between groups. After correcting for multiple comparisons, positive affect alone remained significant. Logistic regression showed that group membership (PLDS vs. recovered from Lyme disease) was predicted by positive affect (p=0.003, Somers' Dxy rank correlation of 0.40) and baseline functional status (p=0.01, Somers' Dxy rank correlation of 0.35). No other variables were predictive of group status at one year. At baseline, positive affect and functional status were not correlated (r=0.06).

Conclusion:

Almost one third of Lyme disease patients will manifest chronic symptoms post antibiotic treatment. Consistent with others, we found worse functional status at baseline to be predictive of PLDS. Further, we found that a resilience factor, positive affect, was the most valuable factor for predicting outcome in this population. Patients with higher levels of positive affect were more likely to fully recover from Lyme disease after treatment. Typically, psychological batteries only measure negative factors, but these data are consistent with emerging data in other fields that suggest that positive factors at baseline may better predict outcomes than negative factors.

To cite this abstract, please use the following information:
Hassett, Afton L., Shlimbaum, Terry, Radvanski, Diane C., Herman, David J., Nahass, Ronald, Buyske, Steven, et al; A Prospective, Longitudinal Cohort Study Evaluating Psychosocial Risk and Protective Factors for Post Lyme Disease Syndrome. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1320
DOI: 10.1002/art.29086

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