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. 2025 Apr 18;17(4):e82541.
doi: 10.7759/cureus.82541. eCollection 2025 Apr.

Prevalence of Rheumatoid Factor and Anti-citrullinated Protein Antibodies in Patients With Post-treatment Lyme Disease

John B Miller  1 , Alison Rebman  2 , Ting Yang  1 , John Aucott  2
Affiliations

Prevalence of Rheumatoid Factor and Anti-citrullinated Protein Antibodies in Patients With Post-treatment Lyme Disease

John B Miller et al. Cureus. .

Abstract

Post-treatment Lyme disease (PTLD) occurs in a portion of patients after initial antibiotic treatment of Lyme disease (LD) and is often characterized by arthralgia without synovitis. Rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are often used to assess joint pain in this setting; however, their clinical utility remains unknown. Our objective was to define the frequency of these autoantibodies in a large cohort of carefully characterized patients with PTLD meeting a research case definition and to determine the clinical implications of these tests. RF and ACPA were tested as indicated clinically and abstracted by chart review. The prevalence of antibodies and their relationship to symptoms were examined. Of the 167 patients included in the analysis, RF status was documented at least once for 78.4% (131 of 167), and ACPA status was available at least once for 88.0% (147 of 167). RF was positive in 3.8% (five of 131), and ACPA was positive in 4.8% (seven of 147) at least at one time point. A total of 7.2% (12 of 167) patients were found to have a positive RF or ACPA test at least at one time point. There was no difference in the proportion of patients with RF and/or ACPA based on the initial presenting manifestations of their LD, nor the symptoms of PTLD at later evaluation; however, the small sample size may limit our ability to detect these clinical differences. We found a low prevalence of RF and ACPA in this study, similar to the known rates in the general population. This reflects the lack of inflammatory arthritis in this population with clinically defined PTLD and arthralgia only.

Keywords: anti-citrullinated protein antibodies; lyme disease; post-treatment lyme disease syndrome (ptlds); rheumatoid arthritis; rheumatoid factor (rf).

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flowchart of patients included in the study
RF, rheumatoid factor; ACPA, anti-citrullinated peptide antibodies
See this image and copyright information in PMC

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