Steroids, NSAIDS and Lyme disease

May 22, 1999

Old post:

Subject: Lyme Disease and Steroid Use

From: jwissmille@... (JWissmille)

Date: 1998/02/13

source: Lyme Disease 1991: Patient/Physician Perspectives from the U.S.

and Canada--- Lora Mermin, editor

Antibiotics and Steroids

by Drulle, M.D.

" Corticosteroids, or steroids as they are commonly called, are very

important drugs in a wide variety of medical conditions. They exert an

anti-inflammatory

effect and suppress the immune system. This may be life saving in some

diseases such as asthma and malignancies. On the other hand, steroids are

rarely curative, and are associated with harmful side effects if used for

prolonged periods of time. These include bone loss, cataracts, sodium

retention, weight gain, abnormal fat distribution and predisposition in

other infections.

" The use of steroids in infectious diseases has always been controversial.

It is well known that steroids can reactivate dormant tuberculosis

infections. Recent studies have shown that in meningitis infections steroids

may decrease the incidence of post infectious complications. However, in

cases of septic shock, their ability to improve survival rates is dubious.

We have been traditionaly taught that in bacterial infections an intact,

well-functioning immune system is necessary in order to recover. Steroids

in the face of bacterial infections may alter the prognosis and in

tuberculosis may actually increase the risk of fatality.

" Since Lyme is a bacterial infection, the question naturally arises as

to what is the role of steroids in Lyme disease. Before the bacterial

nature of Lyme was discovered, it was common to treat the arthritis

complications and heart blocks with steroids. Early reports suggested that

the heart blocks responded well to the steroids. However, in one report

dealing with patients with Lyme arthritis, steroid injections into the

joints prior to antibiotic therapy were associated with a worse prognosis

when antibiotics were finally given. We have seen literally dozens of

patients with Lyme who were initially treated with steroids who reported a

dramatic worsening rather than improvement as would be expected. Dr. ph

Burrascano has coined the expression, ' Steroid Disasters, ' to describe

these patients.

" It is interesting to note that in dogs who had Lyme disease, injections

of dexamethasone, a corticosteroid, enabled Borrelia burgdorferi to be

cultured from blood drawn on the following day. This was done by Dr.

Burgess at the University of Wisconsin. This suggests that the

steroid suppresses a mechanism for keeping the bacteria out of the

circulatory system, since ordinarily it is difficult to grow the Lyme

organism from the blood. Entrance of the bacteria into the bloodstream can

allow seeding of other organs. " I have used steroids in Lyme patients,

but only in very selected circumstances. In patients who have presented

with eye involvement with rapidly deteriorating vision, such as optic

neuritis or uveitis, the combination of high dose steroids appears to

restore vision more rapidly than by using antibiotics alone. I have also

used steroids in combination with antibiotics in patients who presented

with a Lyme induced polymyalgia rheumatica (PMR).

" PMR is a common disease of elderly people characterized by pain and

stiffness in the muscles of the upper arms and legs, fevers, malaise and

weight loss. The ESR, sedimentation rate is elevated. In its classic form,

the cause of the condition is unknown, and the dramatic response to steroids

is in itself diagnostic. I have personally seen three cases of Lyme induced

PMR, which did not respond to steroids alone or antibiotics alone, yet when

the combination was given the response was dramatic.

" In conclusion, the decision to use the steroids in a Lyme patient must

be given considerable thought and the possible benefits must be weighed

against the risks. I would not use steroids unless the patient was also on

antibiotics. "

source: When to Suspect Lyme Disease by D. Bleiweiss, M.D.

" ....I routinely advise my patients with LD to abstain from cigarettes,

alcohol and

steroids because therapeutic inadequacy or an avoidably prolonged

convalescence is frequent (Dattwyler, RJ, Lancet 1:687, 1987 - on steroid

use). Patients have described clinical deterioration when steroids were

used fortuitously or intentionally when hypoadrenalism was absent. Another

hazard attending palliative steroid use is that some symptoms will be

concealed, rendering the clinical picture less interpretable. In a

privatecommunication, a physician reelated that one of his LD patients

succumbed to fatal cardiomyopathy after receiving steroids. One helpful

caveat is to avoid the use of electric blankets or sleeping in water beds

with the electric current activated, otherwise you might wake up with one or

more LD symptoms. Allergic and chemical hypersensitivities can enhance or

cause symptoms to emerge temporarily..... "

WHEN TO SUSPECT LYME DISEASE

D. Bleiweiss, MD

Trenton, NJ 4/94

" ..............Diagnostic inaccuracy will be minimized by not indolently

attributing all problems following head trauma to the most obvious cause. I

routinely advise my patients with LD to abstain from cigarettes, alcohol and