Why Some Lyme Borreliosis Patients Are Not Receiving Treatment

Some patients with Lyme borreliosis are told they do not have treatable disease—despite ongoing symptoms.

A study by Roaldsnes and colleagues evaluated 110 patients with muscular and joint pain, fatigue, memory, and concentration impairments who were assessed for possible Lyme neuroborreliosis.

These patients had non-specific neurological symptoms. “Only one patient was diagnosed with possible Lyme neuroborreliosis. Altogether, 27% had high levels of Borrelia-IgG serum antibodies,” the authors write.

When Symptoms Are Dismissed

Many of the patients had symptoms lasting more than one year. According to Bjark, this led to the conclusion that Lyme borreliosis was not a relevant diagnosis.

“It is difficult to read the article in any other way than this: that if a patient has had these symptoms for such a prolonged period, Lyme borreliosis is not a relevant diagnosis,” Bjark explains.

He adds that patients with suspected Lyme disease—but without abnormal cerebrospinal fluid findings—are often told they do not have any form of Lyme borreliosis requiring treatment.

The Risk of Under-Treatment

Another editorial reinforces this position, stating that patients who do not meet strict diagnostic criteria for Lyme neuroborreliosis should not be treated with antibiotics.

However, Bjark challenges this approach.

A prolonged illness with fatigue, myalgia, and elevated Borrelia-IgG antibodies should not automatically be dismissed as a non-disease.

Some neurologists deny the existence of musculoskeletal borreliosis, but this remains a point of clinical debate.

Clinical Perspective: Individualized Care Matters

Bjark argues that patients should be evaluated and treated on an individual basis.

“If they are left untreated, it is impossible to know whether these are patients who would benefit from targeted antibiotic therapy,” he writes.

He notes that some patients improve with treatment, possibly due to normalization of cytokines and reduction of Borrelia-specific immune complexes.

“Based on my long experience with a large number of Lyme borreliosis cases, I believe that each patient must be assessed individually,” Bjark concludes.

Failure to individualize care may leave patients untreated—and symptomatic.

Learn more about Lyme disease testing and diagnosis and why strict criteria may miss clinically relevant cases.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

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