JAMA Review Overlooks Chronic Manifestations of Lyme Disease
A JAMA review concluded that short courses of antibiotics—such as 10 days of doxycycline for erythema migrans and 14 days for early neurologic Lyme disease—are effective. :contentReference[oaicite:0]{index=0}
However, the review excluded a substantial body of literature describing persistent symptoms and chronic manifestations of Lyme disease.
What Was Included—and What Was Not
The authors based their conclusions on 7 clinical trials and 88 observational studies. Yet nearly 300 publications—including case reports and studies describing persistent illness—were excluded.
Notably, the review does not address persistent Lyme disease mechanisms or the clinical patterns seen in patients who remain symptomatic after treatment.
Important Findings Left Out
For example, a Norwegian randomized trial comparing doxycycline and ceftriaxone found no treatment failures.
However, the review does not highlight that:
- 59% of patients reported residual symptoms at 4 months
- Many had neurologic involvement, including cranial neuropathy and radiculopathy
Absence of treatment failure does not necessarily mean full recovery.
Evidence of Persistent Symptoms
Additional studies describe ongoing illness after treatment:
- 34–62% of patients remained symptomatic in retrospective cohorts
- 57% of neuroborreliosis patients remained ill an average of 5.7 years later
- At 6 months, 36% reported fatigue, 20% pain, and 45% cognitive difficulties
These findings are consistent with what is now described as post-treatment Lyme disease syndrome (PTLDS).
A Question of Interpretation
The review’s conclusions may reflect differences in how Lyme disease is defined and studied.
One of the authors has previously questioned the existence of chronic Lyme disease, highlighting the ongoing debate within the medical community.
Clinical Perspective
The JAMA review provides useful guidance for early Lyme disease but does not fully address patients with persistent symptoms.
When a significant proportion of patients remain symptomatic after treatment, these outcomes warrant consideration in clinical decision-making.
Patients may benefit from understanding persistent symptoms, reviewing treatment variability, and considering coinfections when recovery is incomplete.
Key Takeaway
The JAMA review supports short-course therapy for early Lyme disease—but does not fully address the substantial number of patients who continue to experience persistent symptoms after treatment.
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
