Lyme Arthritis Treatment – Photochemotherapy

by lmatthews on September 8, 2011

Lyme arthritis affects thousands of people each year in the US and can begin within weeks of being infected with Borrelia. Lyme arthritis treatment should be commenced as soon as possible as untreated Lyme disease can lead to permanent joint problems. Most people with arthritis caused by Lyme disease will have their symptoms resolved when the bacterial infection is eradicated but for others it can lead to a lifetime of joint problems with seemingly no cure. One treatment strategy that is rarely used but shows some promise is extracorporeal photochemotherapy (ECP), which has also been in the spotlight recently for its potential to treat ankylosing spondylitis.


Evidence for ECP Use in Lyme Disease

Despite some studies conducted a decade or so ago, there has been little investigation into the use of ECP for arthritis and associated conditions in recent years. This may be due to cost, but is most likely a result of the effectiveness of other available treatments for autoimmune conditions causing joint problems (disease modifying agents). Lyme arthritis is a challenging condition to manage however, with some physicians maintaining that it simply does not exist, others that it is a result of joint damage incurred by the infection (now cleared), and a handful considering the symptoms a result of an induced autoimmune issue created by the ability of the Borrelia burgdorferi bacteria to confuse the immune system. Without a consensus on the mechanism behind Lyme arthritis it is hard for researchers to carry out treatment studies that are likely to satisfy the scientific community and those providing funding.

How ECP Might Work for Lyme Arthritis

Extracorporeal photochemotherapy involves the patient being given an oral dose of methoxypsoralen before having their blood drawn and treated. The blood is held under ultraviolet A light at room temperature before being infused back into the patient. The chemotherapy drug’s photoreactivity causes it to change into its active form for a fraction of a second under the UV light before returning to the inactive state. Patients undergoing such therapy are usually given two sessions over consecutive days once a month, for three to six months, sometimes with a maintenance dose bimonthly for up to a year.

What Happens in an ECP Session?

During the sessions only around 10% of the lymphocytes in the blood are treated, meaning that the success of treatment is unlikely to be due to the death of troublesome immune system cells but a result of some other mechanism. Speculation over the nature of this mechanism is ongoing, with some researchers considering it a consequence of structural changes in DNA in the cells being passed in to other cells following the blood being infused back into the patient. It could also be a result of the more thorough eradication of bacterial remnants after Lyme disease treatment. Additionally, the effects of methoxypsoralen on amino acid residues in the blood may have the effect of inactivating certain enzymes, prompting an improvement in joint conditions like arthritis from Lyme disease.

lyme arthritis mechanisms immune system

The immune system's role in Lyme arthritis

That there is so little research being conducted into Lyme disease itself, Lyme arthritis in particular, and no research being carried out into photopheresis for Lyme arthritis makes it very difficult for a treating physician to determine the possible benefits for a patient with the condition. Just one paper appears in the medical literature regarding a patient treated with ECP for Lyme arthritis, and yet the benefit from this treatment was significant (Randazzon, et al, 1994) and the therapy is used in other cases of autoimmune arthritis.

More Research Needed into Lyme Disease and Arthritis Treatment

Of two clinical trials currently underway into Lyme disease neither involve intervention, with both concerned instead with observation of the disease’s symptoms, progression, and persistence of infection. With Lyme disease considered a growing problem, particularly in the US, it is surprising that so little is being done to research the infection and its repercussions. Meanwhile, some doctors, considered to be Lyme Literate Medical Doctors, offer patients therapies such as extracorporeal photochemotherapy to ameliorate or treat Lyme arthritis without there being a clear understanding of how it might affect the patient and their condition.

How Safe is Photochemotherapy for Lyme Disease?

The case study presented by Randazzo, et al, back in 1994 detailed a patient undergoing photopheresis with successful resolution of the signs and symptoms of chronic Lyme arthritis. The study, published in the Journal of the American Academy of Dermatology, joins others investigating this therapy for chronic joint issues and autoimmune joint problems, such as ankylosing spondylitis, rheumatoid arthritis, psoriatic arthritis, and even systemic lupus erythematosus as it affects the joints and the skin.

Photopheresis does not suppress the immune system, like steroid medications for inflammatory joint conditions, and does not, therefore, necessarily compromise the patient suffering a persistent infection. Instead, the therapy appears to modulate the immune system and alter the expression of autoimmune mechanisms. Some physicians may already be using such experimental therapy without evidence of safety, and without contributing their expertise to the general medical community. This unmonitored use makes it even more important that the potential benefits of extracorporeal photochemotherapy for Lyme arthritis are further investigated so as to safeguard patient health and offer the best Lyme disease treatment possible.


References

Randazzo, J.P., DiSpaltro, F.X., Cottrill, C., Klainer, A.S., Steere, A.C., Bisaccia, E., Successful treatment of a patient with chronic Lyme arthritis with extracorporeal photochemotherapy, Journal of the American Academy of Dermatology, Volume 30, Issue 5, Part 2, May 1994, Pages 908-910.

Akay BN, Sanli H, Kutlay S., Treatment of ankylosing spondylitis by extracorporeal photochemotherapy given for mycosis fungoides: a potential treatment option? J Clin Rheumatol. 2011 Aug;17(5):278-80.

Leaders, Is there a future for extracorporeal photochemotherapy in the treatment of the rheumatological diseases? Annals of the Rheumatic Diseases 1997;56:339–342

Malawista SE, Trock DH, Edelson RL. Treatment of rheumatoid arthritis by extracorporeal photochemotherapy: a pilot study. Arthritis Rheum 1991;34:646-54.

Vahlquist C, Larsson M, Ernerudh J, Berlin G, Skogh T, Vahlquist A. Treatment of psoriatic arthritis with extracorporeal photochemotherapy and conventional psoralen-ultraviolet A irradiation. Arthritis Rheum 1996; 39:1519-23.

Macheiner W, Jantschitsch C, Graninger W, Pálóczy K, Bálint G, Marschalkó M, Kainberger F, Breier F, Knobler RM., Sézary syndrome and seronegative polyarthritis: treatment with extracorporeal photochemotherapy. J Am Acad Dermatol. 2003 Feb;48(2):220-6.

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