22 July, 2011

The good, the bad and the ugly of Lyme disease treatment

Treating human disease is difficult for a number of reasons, not least the fact that patients have preconceptions about what treatments they want to receive. If a doctor prescribes a certain medication, and the patient - in full knowledge of the facts - decides not to take it, then there is not much more that the doctor can do. A case in point is highlighted in the March 2011 edition of Nature Reviews Rheumatology, specifically in a Case Study article entitled: "A case revealing the natural history of untreated Lyme disease".

In this article, a rheumatologist named Robert T. Schoen recounts the story of a patient he had who was determined to use a combination of acupuncture and homeopathy to cure her Lyme disease, a condition brought about by a bite from a tick of the Borrelia genus. Although the alternative treatments occasionally gave her some relief from her symptoms (the placebo effect - alive and strong), her Lyme disease, and painful arthritic episodes, kept coming back.

But still, she refused to take antibiotics:

The rheumatologist confirmed the diagnosis of Lyme arthritis and prescribed amoxicillin (500 mg, three times daily for 28 days) to hasten the resolution of the current episode of arthritis and to prevent subsequent flare-ups. The patient initially agreed to take this treatment and to return at the completion of antibiotic therapy. When seen a month later, however, she had not taken any of the prescribed antibiotic therapy.

Medically speaking, this was obviously not an ideal situation for the patient. However, through her refusal to accept the convential Lyme disease treatment, the disease was able to progress naturally over a period of almost 4 years - Lyme disease is usually treated successfully with antibiotics. This situation gave the doctors a unique opportunity to study how the disease progresses and, ultimately, determine how effective the conventional treatments are following such a long disease period.

Below is a timeline for the four years (click to enlarge). Symptoms are displayed above the timeline. The visits to the homeopath, acupuncturist and rheumatologist are color-coded and displayed below the timeline.

Notice how even the homeopath eventually admitted defeat and prescribed antibiotics for the patient - and she still didn't take them!

Eventually, after four years of failed alterntive treatments, the patient was in so much pain that she had confined herself to bed for a month. She relunctantly visited and listened to the advice of a rheumatologist and took a 30-day course of doxycycline. Six months later, she had no further arthritis and remained well.

Schoen concludes:

...patients who are not treated with antibiotic therapy are known to have recurrent episodes of oligoarthritis, often affecting the knee. Indeed, this Case Study demonstrates that Lyme arthritis, if untreated, continues to occur in a well-characterized pattern that can last for years. Furthermore, the arthritis in this patient is thought to have resulted from B. burgdorferi infection (in the absence of previous antibiotic therapy) rather than a postinfectious inflammatory process, and her condition was cured with a relatively short course of antibiotic treatment. The clinical identification of this increasingly uncommon long-term form of Lyme arthritis is important and appropriate management, even at this late-stage of disease, can result in gratifying treatment outcomes.

This case shows two things quite clearly:

1 - Even after four years of allowing Lyme disease to progress naturally, the patient was still successfully treated with antibiotics (the good)

2 - Acupuncture (the bad) and homeopathy (the ugly) are not effective at treating Lyme disease

The first point above bodes well for Lyme disease patients; conventional medicine can still be effective, even years after contracting the disease.

The second point simply serves as a warning to those who seek out unproven remedies for serious illnesses - do so at your own peril.

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