From the Guidelines
The most effective way to test for Lyme disease is through a two-step blood test, starting with an enzyme-linked immunosorbent assay (ELISA) followed by a Western blot test, as recommended by the Infectious Diseases Society of America 1. This approach is supported by the most recent and highest quality studies, which emphasize the importance of accurate diagnosis to prevent serious complications. The two-step test is most accurate when performed at least a few weeks after infection, as it takes time for antibodies to develop. Early testing may yield false negatives, so it's essential to consider the timing of the test in relation to the suspected infection. In some cases, doctors may also use polymerase chain reaction (PCR) tests on joint fluid or spinal fluid to detect bacterial DNA, though this is less common. Key points to consider when testing for Lyme disease include:
- The two-step blood test is the most effective method for diagnosis
- The test is most accurate when performed at least a few weeks after infection
- Early testing may yield false negatives
- PCR tests may be used in some cases to detect bacterial DNA
- Accurate diagnosis is crucial to prevent serious complications, including arthritis, neurological problems, and heart issues. If you suspect Lyme disease due to symptoms like a bull's-eye rash (erythema migrans), fever, fatigue, or joint pain after a tick bite, seek medical attention promptly, as treatment with antibiotics like doxycycline, amoxicillin, or cefuroxime is most effective when started early, typically for 14-21 days 1.
From the Research
Diagnostic Testing for Lyme Disease
- The primary diagnostic test for Lyme disease is the standard 2-tier testing (STTT) which incorporates a screening enzyme immunoassay (EIA) or an immunofluorescence assay (IFA) that reflexes to IgM and IgG immunoblots 2.
- In 2019, the Food and Drug Administration approved a modified 2-tier test strategy using 2 EIAs, offering a faster, less expensive, and more sensitive assay compared with STTT 2.
- New technologies that examine early immune responses to Borrelia burgdorferi have the potential to diagnose Lyme disease in the first weeks of infection when existing serologic testing is not recommended due to low sensitivity 2.
Clinical Diagnosis and Treatment
- The diagnosis of Lyme disease is based on clinical manifestations and adjunctive laboratory testing 3.
- For the rheumatologist, Lyme arthritis should be recognized by a pattern of attacks of asymmetric, oligo-arthritis, recognizable by clinical manifestations in the same way that other rheumatic diseases, such as gout or rheumatoid arthritis, are diagnosed 3.
- Almost all patients with early Lyme disease can be cured with antibiotic treatment, and in most cases, Lyme arthritis also responds to antibiotics, but some patients require additional treatment approaches 3.
Guidelines for Clinical Laboratory Diagnosis
- The Centers for Disease Control and Prevention (CDC) recommend the use of a 2-tiered serologic testing algorithm for the evaluation of patients with suspected Lyme disease 4.
- The CDC's established guidelines provide doctors of chiropractic with information to remain current with the recommended guidelines for Lyme disease testing because patients may present to their office with the associated signs and symptoms of Lyme disease 4.
Cost-Effectiveness of Test-Treatment Strategies
- The cost-effectiveness of test-treatment strategies for patients suspected of having Lyme disease depends on the patient scenario, with different strategies being most economically attractive for different scenarios 5.
- For myalgic symptoms without other features suggestive of Lyme disease, the no testing-no treatment strategy is most economically attractive, while for rash, empirical antibiotic therapy is less costly and more effective than other strategies 5.
- For oligoarticular arthritis with a history of rash and tick bite, two-step testing is associated with the lowest cost-effectiveness ratio 5.