Is Suppressing Immunity Harmful to Lyme Disease Patients?
Some Lyme disease patients take medications that suppress the immune system to treat autoimmune or inflammatory diseases. But does suppressing immunity worsen Lyme disease? A study examining Lyme disease patients receiving tumor necrosis factor-alpha (TNF-α) inhibitors found these individuals were more likely to develop complications and treatment failure.
The authors compared 16 individuals with Lyme disease who were receiving TNF-α inhibitors with 32 healthy controls. All patients had confirmed Lyme disease with an erythema migrans rash manifestation.
The patients received immune-suppressing medications including adalimumab, infliximab, etanercept, and golimumab. These medications suppress tumor necrosis factor-alpha (TNF-α), an important component of the immune system that helps the body control infections.
The drugs were often combined with other immunosuppressant medications for rheumatic disease (13 patients) or inflammatory bowel disease (3 patients).
Lyme Disease Outcomes in Immunosuppressed Patients
Investigators found that, compared with controls, patients receiving immunosuppressive therapy had:
- More frequent comorbidities other than immune-mediated diseases (62.5% vs. 25%)
- Symptoms or signs of disseminated Lyme borreliosis (18.8% vs. 0%)
- Higher rates of treatment failure (25% vs. 0%)
Overall, 4 out of 16 (25%) Lyme disease patients treated with immunosuppressive therapy experienced treatment failure. Three of these patients required retreatment with antibiotics, and one patient became significantly ill.
“The immunocompromised patients were also more likely to fail treatment than patients who were not immunocompromised,” writes Maraspin.
A Case of Relapse After Treatment
The fourth patient, a 44-year-old man, initially appeared well at his six-month follow-up visit. However, seven months after beginning antibiotic treatment he developed severe arthralgia, fatigue, and back pain.
“Seven months after beginning antibiotic treatment he developed severe arthralgia, fatigue and back pain,” writes Maraspin in the Journal of Clinical Medicine.
A specialist was consulted but could not determine whether the symptoms represented a relapse of rheumatoid arthritis. The patient remained ill for the next five months.
Laboratory testing revealed his IgG antibody level to VlsE borrelial antigens rose from 542.1 to 1462.0 AU/mL.
His symptoms improved following retreatment with the antibiotic ceftriaxone.
Clinical Implications for Lyme Disease Patients
This study raises concerns about whether suppressing immunity may worsen outcomes for some Lyme disease patients.
Patients receiving immune-suppressing medications may be at increased risk for disseminated Lyme disease or treatment failure. These findings suggest that careful monitoring and follow-up are important when Lyme disease occurs in individuals whose immune systems are suppressed.
Some clinicians also remain concerned that immune suppression could allow persistent Lyme infection to continue in certain patients.
The authors recommend regular follow-up visits to better understand whether suppressing immunity may affect Lyme disease outcomes.
Related Articles:
Persistent Lyme infection or inflammatory immune response?
References:
- Maraspin V, Bogovič P, Rojko T, et al. Early Lyme Borreliosis in Patients Treated with Tumour Necrosis Factor-Alpha Inhibitors. Journal of Clinical Medicine. 2019.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
As far as I am concerned a misdiagnoses of Chrohn’s disease which was totally wrong and the introduction of IV steroids with follow up 60mg. prednisone for months and months is what ruined my life. By suppressing my immune system my neurological lyme got so severe that the following occurred. Difficulty breathing, difficulty swallowing, increased myoclonus(jerking of limbs involuntarily), felt like I was going to have a full blown seizure, tinnitus got much worse. If I could have found an open window in that hospital I would have jumped! After refusing feeding tubes because they had no idea what the hell was wrong with me I pleaded with my wife to get me a hospital bed at home and that’s where I lay for 2 years.
After leaving the hospital my bowel motility shut down for 12 days, muscle twitching increased dramatically, severe headaches. Upon flouroscopy, laprascopic abdominal surgery it was determined there was no Chrohn’s disease. The great imitator hit me hard. Thankfully a gastroenterologist determined that I just had a severe irritable bowel more than likely from nerves irritated to the bowel from Lyme. He weaned me off steroids slowly but it had done its damage to me. I don’t know about other Lyme patients but after what I have been through from 1993 to this day I would stay away from anything that lowered my immune system.
I was diagnosed with MS. Took immunosuppressants for two years before stopping against Dr advice. I went downhill so fast I knew there was something else happening. Three more years passed before I got an out of country Lyme diagnosis. Sadly my neurologist could have this study in his hands and would have still told me I need to keep on his immunosuppressant treatment plan.
My daughter who had Lyme was prescribed prednisone because she always had swollen glands and a sore throat. (chronic EBV) The next twelve years were hell for her and then she died.
We need more research in this area. I shared the finding in this Blog to encourage more research.
How should someone treat something like lupus?
The treatment often consists of medications to suppress the immune system. There are a growing number of treatments available to rheumatologist. Lupus can be difficult to diagnosis in some patients. I have had some patients where treatment for Lyme disease has been helpful.
In a chronic Lyme/TBD patient diagnosed with autoimmune disease (Lupus, Sjogren’s, etc) where both diseases need treatment concurrently how do you balance the need for DMARDS like methotrexate (and possibly anti TNF meds)
There are treatments to suppress the immune system. Rheumatologists have a growing number of choices.
It’s challenging to find a rheumatologist that believes in chronic TBD’s
I was in remission for 24 years after being treated for 14 months of Iv antibiotics. I had an occasional flare-up which I treated with natural immune supporters and diet. Last year I went to the hospital for chest pains and they gave me Pregnesone an I’ve been sick ever since. I have Uticaria welts all over my body with itching and pain. I have bouts where I can’t breathe. The first thing they want to do is put me back on Prednisone and that’s what caused me to go out of remission!
I’ve got knee pain so bad now I can’t walk, confusion, dizziness, chest pain and irregular heartbeat, and excruciating headaches
It’s exactly the same symptoms I had when I first got bit… Never never take this stuff if you have Lymes!
I have developed joint pain and stiffness suddenly over last 3 to weeks. My docs say polymyalgia rheumatica. Hands, fingers, knees, feet. Ive had tick butes bur no rash. Rt eye droop at times. I take remicade, for pyoderma, actemra fot giant cell and methotrxate. Would you recommend lyme test and do drugs affect results?
Polymyalgia Rheumatica and Lyme disease look alike. I typically look a second time at a tick borne illness even if my patients respond to steroids.
I am presenting with signs of Lyme after a tick bite in June. No rash and IGG/IGM test was negative. Is it possible that I have Lyme?
The tests are not as reliable as I would like. I have to look for other illnesses if the IgG/IgM are negative. I also look for evidence of co-infections. Lastly, I often have to use clinical judgment if the tests are negative and I can’t find another answer.