Steroid use can lead to long-term treatment failure for Lyme disease patients

Several studies have documented the consequences steroids pose to patients with Lyme disease. Most recently, researchers from Massachusetts Eye and Ear and Harvard Medical School published a retrospective study which described an "association between corticosteroid use in acute LDFP [Lyme disease-associated facial palsy] and worse long-term facial function outcomes." [1]

 

by Daniel J. Cameron, MD MPH

Physicians are warned of the importance in distinguishing between viral or idiopathic facial paralysis (e.g., Bell’s palsy) from Lyme disease-associated facial palsy. Authors of the study, “Steroid Use in Lyme Disease-Associated Facial Palsy Is Associated With Worse Long-Term Outcomes,” used the term Lyme disease-associated facial palsy (LDFP) rather than Bell’s palsy to highlight the differences in pathophysiologies between viral and idiopathic facial palsy.

LDFP was presumed to be the consequence of a humoral immune neuropathy rather than cell-mediated autoimmunity or edematous compressive neuropathy as seen with viral-induced Bell’s palsy. [1] “If LDFP is a humoral immune neuropathy, corticosteroid therapy may be ill-advised,” states Jowett and colleagues. [1]

Man with Bell’s palsy paralysis of the facial nerve.

The authors expressed concern that two-thirds of the 51 study participants had been prescribed corticosteroids.

“Because corticosteroids are the standard of care for acute viral facial paralysis, it is not surprising that they were prescribed to nearly all patients who were initially misdiagnosed as having such.” [1]

Other studies have described long-term treatment failures for Lyme disease (LD) patients following use of steroids. [2,3] Treatment failures were found in Lyme arthritic patients who were treated with intramuscular (IM) benzathine penicillin following steroids. [3]

In another study, two patients were ill for 3 years and one patient for 6 years despite receiving intravenous (IV) ceftriaxone. The authors explained, “Patients unresponsive to ceftriaxone were more likely to have received corticosteroid treatment.” Dattwyler et al. from Stony Brook Medical Center found an “association of steroid use with an increased failure rate or worsening of disease is understandable in view of the well-known effects of these agents on the inflammatory and immune responses.”

Dattwyler advised against the use of steroids in Lyme disease patients based on these two studies. “In view of the strong association between the use of steroids and the lack of response to antibiotic therapy, we believe that glucocorticoids should not be used in the treatment of Lyme borreliosis.” [2]

Treatment failures following steroids were also reported in a case series of recurrent Lyme disease by Cameron. [4] In the series, a 75-year-old man was prescribed diuretics for edema followed by steroid injections for a swollen knee. An 18-year-old woman with a 4″ x 4″ rash followed by pericarditis was treated with steroids instead of antibiotics. A 37-year-old man with disseminated early Lyme disease (LD) rashes and asthmatic bronchitis was treated initially with steroids instead of antibiotics.

Complications have also been reported in canine-infected Borrelia burgdorferi. [5] Dogs succumbed to arthritis after prednisone use. Straubinger found “corticosteroids inhibit the regulation of cytokines at the DNA level, thus handicapping leukocyte communication during treatment.” [6]

An association of steroid use with an increased failure rate or worsening of disease is understandable in view of the well-known effects of these agents on the inflammatory and immune responses. [2]

A study of Post-Treatment Lyme Disease Syndrome (PTLDS) supports concerns that the pathophysiology of LD is partly a consequence of a humoral immune response. The T-cell chemokine CCL19 remained high in 14% of Lyme disease patients despite a 3-week course of antibiotics. The level of the T-cell chemokine CCL19 for these patients was 12 times higher than for LD patients who were successfully treated with 3 weeks of antibiotics alone. [7]

“Individuals with ideally treated early Lyme disease have a greater than 12-fold higher risk of developing PTLDS by six or twelve months post-treatment if their CCL19 level is higher than 111.67 pg/ml at one month post-treatment,” writes Aucott and colleagues.

These studies remind us of the need to avoid steroids in patients who may have Lyme disease to avoid long-term treatment failure.

 

References:

  1. Jowett N, Gaudin RA, Banks CA, Hadlock TA. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope, (2016).
  2. Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ. Treatment of late Lyme borreliosis–randomised comparison of ceftriaxone and penicillin. Lancet, 1(8596), 1191-1194 (1988).
  3. Steere AC, Green J, Schoen RT et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med, 312(14), 869-874 (1985).
  4. Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract, 13(3), 470-472 (2007).
  5. Straubinger RK, Straubinger AF, Summers BA, Jacobson RH. Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study. J Infect Dis, 181(3), 1069-1081 (2000).
  6. Straubinger RK, Straubinger AF, Summers BA, Jacobson RH, Erb HN. Clinical manifestations, pathogenesis, and effect of antibiotic treatment on Lyme borreliosis in dogs. Wien Klin Wochenschr, 110(24), 874-881 (1998).
  7. Aucott JN, Soloski MJ, Rebman AW et al. CCL19 as a Chemokine Risk Factor for Post-Treatment Lyme Disease Syndrome: A Prospective Clinical Cohort Study. Clin Vaccine Immunol, (2016).

 


10 Replies to "Steroid use can lead to long-term treatment failure for Lyme disease patients"

  • Harold
    01/11/2019 (2:53 am)
    Reply

    Here’s my comment.. everyone says no to steroids and Lyme disease.. so what does that mean?? Does it mean no to continual use and constant use of steroids… or no to not even one??? I have Lyme disease and co-infections and I have been suffering with severe lower back pain and three pinched nerves for over 2 months… I’m getting ready to go to one of the best Lyme clinics in the country but I cannot go with excruciating back pain… the clinic that I’m going to set it will be fine for me to have a shot in my lower lumbar… but everyone on the internet and everyone I talk to says no no no no… so what am I supposed to do go to a clinic for 4 months they cost $80,000… and not only suffer through treatment but also debilitating lower back pain.. with three pinched nerves and sciatica??? What’s the harm in one shot??? This Clinic says I’ll be fine because the first three weeks they will be boosting my immune system anyway… so can someone please give me an answer instead of this vague no to steroids.. I understand oral steroids can be bad and constant use of steroids can be bad but does that also apply to one shot??? A response would be nice thank you so much

    • Dr. Daniel Cameron
      01/11/2019 (8:19 am)
      Reply

      Great question. I try to avoid steroids in my patients whether they have Lyme disease or not. I don’t like steroids but I don’t like pain. I have patients with severe enough pain where the benefits of a steroid injection is greater than the risk of steroids in Lyme disease. I keep my patients on antibiotics while being treated with a steroid shot. Of course, the risks are not so clear.

  • Jennifer Lumadue
    04/04/2019 (9:42 pm)
    Reply

    No. Don’t get the shot. No to all steroids. They will lower the immune system and cause worse pain and disease bacteria will spread.
    I have Lyme. took prednisone for 3 days and got bad sick again. wish I never did. I told my dr I had horrible back pain so he gave me steroids. No one believed me that it was the prednisone because it don’t make you sick but with Lyme, yes. worse thing you can do I got bad headaches bloodshot eyes and alot eye pain.

  • Debra B Rushing
    05/04/2019 (7:30 pm)
    Reply

    What is the first thing they do when we start presenting symptoms for rashes/tendonitis/swollen knees/etc…they give us a shot of steroids for a quick fix to a bigger problem….that ends up costing us our health when it is all said and done? Or that was my case…no telling how many shots and packs of steroids I had during the time I was diagnosed with Fibro and CFS…it seems like a racket to make us sicker so they will make more money. Anyone that has any understanding of medicine should be able to go by symptoms…but, they don’t have time to listen…just shoot you up and walk out…knowing they will see us later 🙁

  • S.Lilly
    08/17/2019 (2:13 am)
    Reply

    Dr.Cameron , my husband was initially treated with bactrim and prednisone for the rash that they thought could have been a staph infection. But it did not help at all so he followed up 2 days later where blood work was done but no change in meds. Still no better he followed up again 2 days later and they started him on doxycycline for lymes or other tick related illness and stopped the other 2 meds. 2 days into doxy and rash is starting to clear. He has had no other symptoms through all this. Lyme came back positive. My question is…should we be concerned that he had the prednisone? Also is 10 days sufficient duration for the doxy?

    • Dr. Daniel Cameron
      08/18/2019 (2:08 pm)
      Reply

      Doctors are divided on the duration. I prefer a longer course whether or not steroids were prescribed.

  • BT
    08/30/2019 (6:08 am)
    Reply

    If someone feels better on prednisone, does that imply they don’t have lyme disease? My sister has been taking a course of prednisone for serious arthritic symptoms she has been having. The prednisone relieved her symptoms. Now that they are weaning her off the prednisone, her symptoms are coming back full force. Because of other issues she has (balance problems and glaucoma that resists treatment) I am concerned she has lyme disease. She says if she had lyme disease the prednisone would not have relieved her arthritis symptoms, (even if only initially). Is that true? Or could prednisone work initially but make lyme disease worse once it is stopped?

    • Dr. Daniel Cameron
      08/30/2019 (7:15 am)
      Reply

      I find prednisone can help some Lyme disease patients some of the time as an anti-inflammatory drug. Steroids can give troubles on long term followup in some studies.

  • Ginny Passetto
    09/12/2019 (5:30 am)
    Reply

    Possible Addisons Disease for a person who has had Lyme for over 10 years. Family member going to be soon texted for Addisons Disease. If positive, I have read that hydrocortisone treatments are used, such as prednisone. I also am worried as steroids can create much worse issues for chronic Lyme patients. Are there other alternatives to help with this disease rather than steroid treatment? Thank you!

    • Dr. Daniel Cameron
      09/17/2019 (12:28 pm)
      Reply

      You would need to work with an endocrinologist. In this case, you may have to take enough steroids to correct the Addison’s disease while you are investigated for Lyme disease.


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