Diagnosing Lyme's Malady

In the middle of the night, a Connecticut housewife, 36, awakes with shaking chills, fever and a splitting headache. Some weeks later, she is so crippled by severe pains in her back, knees and shoulders that she cannot walk without crutches. About the same time, a neighbor's son, 6, develops several large reddish rings on his skin. His temperature rises, and within days a swelling in the boy's left knee leaves him virtually immobilized. A short distance away, a robust man, 26, suddenly finds himself battling a nagging sore throat, a stiff neck and total fatigue. Before long, he feels excruciating aches in his shoulders, wrists, elbows, fingers and toes.

For the past few years, usually in summer or fall, dozens of people in eastern Connecticut--both children and adults--have been stricken with these painful and puzzling symptoms, which often come in repeated episodes that last for weeks and even months at a stretch. At first, doctors suspected rheumatoid arthritis, a serious disease of still unknown origin that can permanently cripple the joints. Then, learning that almost all the victims lived in three adjoining towns along the Connecticut River--Lyme, Old Lyme and East Haddam (total population 12,000)--medical investigators from the Yale University School of Medicine came to a decidedly different conclusion. Because rheumatoid arthritis does not occur in clusters, they realized that the illness--dubbed Lyme arthritis--was something new.

Bracelets and Diets. Contrary to popular notions, arthritis--which afflicts millions of Americans--is not a single disease, but a collection of ailments characterized by a common irritation of the joints. In the case of rheumatoid arthritis, some doctors suspect malfunctions of the immune system, perhaps triggered by viruses. Indeed, in recent years, researchers have linked at least four different kinds of arthritis in Africa, Asia and Australia to viruses apparently transmitted by mosquitoes. Other types of arthritis may be bacterial in origin or simply the result of stress at certain joints. In any case, the lack of a clear understanding of many of arthritis' manifestations has complicated treatment; everything from corticosteroids to copper bracelets and special diets has been tried by sufferers. But the most common--and sometimes the best--therapy involves nothing more exotic than aspirin.

The investigation into Lyme arthritis was led by Dr. Stephen Malawista, chief of Yale's rheumatology section, and two colleagues, Drs. Allen Steere Jr. and John Hardin. Because nearly all the victims lived in wooded areas heavily infested with insects, and because the cases usually cropped up at the height of the insect season, the Yale doctors had good reason to suspect that the carrier was a bug. Indeed, some of the victims remembered being bitten by a tick, although their blood has shown no specific signs of a bacterial or viral invasion. Yet recently the Yale doctors found an important clue: sampled early in the course of the disease, the blood of some victims revealed telltale proteins called cryoglobulins,* which may be linked to an immune reaction, and have also been found in such known viral infections as hepatitis B and infectious mononucleosis. More intriguing still, the large red skin patches--up to 50 cm. (20 in.) in diameter--seemed to have erupted at the actual site of tick bites.

Alerted by the Connecticut data, doctors in Massachusetts, Rhode Island and New York have since discovered instances of Lyme arthritis in their own areas. These cases suggest that the disease may have been misdiagnosed or overlooked in the past and may actually be widespread. In fact, in the latest issue of Annals of Internal Medicine, the Yale doctors point out that European doctors have long known of a tick-borne infection called erythema chronicum migrans; it is characterized by a similar reddening, although it has so far never been associated with arthritis. Now the Yale researchers will concentrate on finding the culprit, presumably a tick-borne virus. That should lead to a better understanding of--if not a cure for --Lyme arthritis and also shed light on other forms of the painful disease.

*Because they precipitate out of solution at cryogenic--low--temperatures.

This file is automatically generated by a robot program, so viewer discretion is required.