John 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. Joseph 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. Elizabeth 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."