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False positive seroreactivity to Borrelia burgdorferi in systemic lupus erythematosus: the value of immunoblot analysis

Department of Medicine, Division of Rheumatology, New York University Medical Center, New York, The Department of Rheumatology, Hospital for Joint Diseases Orthopaedic Institute

Victoria A Sadock

Department of Medicine, Division of Rheumatology, New York University Medical Center, New York

Leonard H Sigal

Departments of Medicine and Molecular Genetics and Microbiology at The University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, USA

Mark Phillips

Department of Medicine, Division of Rheumatology, New York University Medical Center, New York

Parvin F Merryman

The Department of Rheumatology, Hospital for Joint Diseases Orthopaedic Institute

Steven B Abramson

Department of Medicine, Division of Rheumatology, New York University Medical Center, New York, The Department of Rheumatology, Hospital for Joint Diseases Orthopaedic Institute

The object of this study was to determine the incidence of seropositivity to B. burgdorferi by the commonly available enzyme-linked immunosorbent assay (ELISA) in patients with SLE and other rheumatic diseases and to evaluate immunoblot analysis as a tool to differentiate true from false positive ELISA. Sera were obtained from patients with SLE (n = 35), rheumatoid arthritis (n = 26), seronegative arthritis (n = 28) and Lyme disease (n = 18). Reactivity to B. burgdorferi antigens was analysed by two available diagnostic techniques: ELISA and immunoblot. Correlations were made between seroreactivity to B. burgdorferi and standard serological tests of autoimmunity: antibodies to nuclear antigens, dsDNA, cardiolipin, SSA and SSB. Seroreactivity to B. burgdorferi antigens by the ELISA system was detected in 40% of patients with SLE, 8% of patients with rheumatoid arthritis and 4% with seronegative arthritis. Among patients seropositive by ELISA, immunoblots were negative in all cases. However, eight of 14 patients with rheumatoid arthritis (57%) showed cross-reactivity to multiple borrelial antigens. No significant correlations were found between Lyme seropositivity by ELISA and other autoantibodies except IgM rheumatoid factor (r = 0.61, P < 0.01 ) in patients with rheumatoid arthritis.

In conclusion: a positive ELISA for Lyme disease was found in up to 40% of patients with established SLE and also in other rheumatic diseases. However, specific serum antibodies to Borrelia were not confirmed by the more specific immunoblot technique. We conclude that immunoblot analysis can help differentiate a false from true positive ELISA for Lyme disease. These findings should caution the clinician with regard to the limitations of current diagnostic testing for Lyme disease, particularly in patients with connective tissue disease.

Key Words: lyme disease • SLE • rheumatic disease • serologic testing • ELISA

Lupus, Vol. 4, No. 2, 131-137 (1995)
DOI: 10.1177/096120339500400209


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