The long-term clinical outcomes of Lyme disease. A population-based retrospective cohort study

Published Date
Annals of Internal Medicine
Ann Intern Med. 1994 Oct 15;121(8):560-7
Shadick NA
Phillips CB
Logigian EL
Steere AC
Kaplan RF
Berardi VP
Duray PH
Larson MG
Wright EA
Ginsburg KS
Katz JN
Liang MH


To ascertain the prevalence of and risk factors for long-term sequelae from acute Lyme disease.


Population-based, retrospective cohort study.


A coastal region endemic for Lyme disease.


Patients with a history of Lyme disease who were previously treated with antibiotics were compared with randomly selected controls.


A standardized physical examination, health status measure (Short Form 36), psychometric test battery, and serologic analysis.


Compared with the control group (n = 43), the Lyme group (n = 38; mean duration from disease onset to study evaluation, 6.2 years) had more arthralgias (61% compared with 16%; P < 0.0001); distal paresthesias (16% compared with 2%; P = 0.03); concentration difficulties (16% compared with 2%; P = 0.03); and fatigue (26% compared with 9%; P = 0.04), and they had poorer global health status scores (P = 0.04). The Lyme group also had more abnormal joints (P = 0.02) and more verbal memory deficits (P = 0.01) than did the control group. Overall, 13 patients (34%; 95% CI, 19% to 49%) had long-term sequelae from Lyme disease (arthritis or recurrent arthralgias [n = 6], neurocognitive impairment (n = 4), and neuropathy or myelopathy [n = 3]). Compared with controls, patients who had long-term sequelae had higher IgG antibody titers to the spirochete (P = 0.03) and received treatment later (34.5 months compared with 2.7 months; P < 0.0001).


Persons with a history of Lyme disease have more musculoskeletal impairment and a higher prevalence of verbal memory impairment when compared with those without a history of Lyme disease. Our findings suggest that disseminated Lyme disease may be associated with long-term morbidity.