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Thursday, May 24, 2018

Lyme arthritis and reactive T cells

A friend told me that a new mouse study gave us the answer regarding Lyme arthritis. 
Not quite.  The study was done at the University of Utah (U of U) in mice.  Mice with Lyme arthritis had severe inflammation with thickened synovium. Low levels of spirochetes, referred to as residual bacteria were usually found in the joints. The pathology and immunology revealed the basis for the inflammation was abnormal T cells. This has been described in the past. 
The germ response immune system has two primary legs:  Killer T Cells vs antibodies (behaving badly).  Most autoimmune diseases -- based on current knowledge are due to antibody responses. 
The first leg, the T cell leg is referred to as the innate immune system.  The antibody side -- connected with B cells comprises the acquired immune responses.  
This is the simplest and easiest way to understand the dichotomy.
Patients may go to rheumatologists and report they have fully tested, they don’t have any autoimmune diseases. Rheumatologist only test for things like rheumatoid factor, CCP antibodies, ANA antibodies and a host of other antibodies. Antibodies which attack our healthy tissues. Not poorly acting T cells.  Commercially available tests only measure autoimmune antibodies. 
There likely exist numerous autoimmune disorders for which there is no available test. The rheumatologist should say that based on currently available tests there is no evidence of an autoimmune disease. 
Lyme arthritis is autoimmune without antibodies.  We know the immune system frequently struggles to make Lyme antibodies, explaining some negative tests in Lyme infected individuals.  
There is no test, especially one that would be agreed upon.
The autoimmune, inflammatory reactions were associated with a small number of residual Lyme bacteria.   Small numbers of spirochetes, stubborn and hard to eradicate may cause a lot of inflammation as we have long suspected. 
There are two belief systems here.
One can choose to believe that the T cell response is part of a self-perpetuating process irrespective of residual or germ. In this case, powerful immune suppressing drugs and/or surgical removing of the synovium, the joint lining is the way to go. Not my opinion.
I have found that long term antibiotics, including IV antibiotics work for most patients. 
This is the rub:  Lyme bacteria are the oxygen which feed the fire – the inflammatory T cell medicated response.  Take away the oxygen and the fire goes out -- the joints improve. 
Lyme is in Utah.
Of course, people (most people,) are not mice. You cannot necessarily generalize mice data to people.

Of course in the film “A hitchhiker’s guide to the galaxy” (spoiler) we ultimately learn that white mice run the world and we humans are the guinea pig test subjects. 
You never know.


Unknown said...

Osteoarthritis is the most common form of the potentially debilitating rheumatoid disease. The disease finds it’s most victims in adults age twenty-five or older. In 2006, nearly twenty-one million Americans were living with this form of arthritis. Also known as degenerative joint disease, osteoarthritis attacks the bone’s cartiledge.

Unknown said...

This article was helpful in concluding that my otherwise "managed" chronic lyme has relapsed as arthritis in my fingers (conventional diagnostics are negative).

However I was puzzled by this phrase: "...inflammatory T cell medicated response". Should this read *mediated* rather than medicated?

Thank you.

Susan said...

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