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Lyme disease associated neurological and musculoskeletal symptoms: A systematic review and meta-analysis

Bushi G 1 , Balaraman AK 2 , Gaidhane S 3 , Ballal S 4 , Kumar S 5 , Bhat M 6 Show all authors , Sharma S 7 , Kumar MR 8 , Sinha A 9 , Khatib MN 10 , Rai N 11 , Sah S 12 , Yappalparvi A 13 , Samal SK 14 , Lingamaiah D 15 , Shabil M 16

Affiliations 

  • 1 Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
  • 2 Research and Enterprise, University of Cyberjaya, Persiaran Bestari, Cyber 11, 63000, Cyberjaya, Selangor, Malaysia
  • 3 One Health Centre, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education, Wardha, India
  • 4 Department of Chemistry and Biochemistry, School of Sciences, JAIN (Deemed to be University), Bangalore, Karnataka, India
  • 5 Department of Allied Healthcare and Sciences, Vivekananda Global University, Jaipur, Rajasthan, 303012, India
  • 6 Department of Medicine, National Institute of Medical Sciences, NIMS University Rajasthan, Jaipur, India
  • 7 Chandigarh Pharmacy College, Chandigarh Group of Colleges-Jhanjeri, Mohali, 140307, Punjab, India
  • 8 Department of Chemistry, Raghu Engineering College, Visakhapatnam, Andhra Pradesh, 531162, India
  • 9 Uttaranchal Institute of Pharmaceutical Sciences, Division of Research and Innovation, Uttaranchal University, India
  • 10 Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India
  • 11 Department of Biotechnology, Graphic Era (Deemed to be University) , Clement Town, Dehradun, 248002, India
  • 12 SR Sanjeevani Hospital, Kalyanpur, Siraha, 56517, Nepal
  • 13 School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India
  • 14 Unit of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, 17177, Stockholm, Sweden
  • 15 Noida Institute of Engineering and Technology (Pharmacy Institute), Greater Noida, India
  • 16 University Center for Research and Development, Chandigarh University, Mohali, Punjab, India
Brain Behav Immun Health, 2025 Feb;43:100931.
PMID: 39867846 DOI: 10.1016/j.bbih.2024.100931

Abstract

BACKGROUND AND OBJECTIVE: Lyme disease, caused by Borrelia burgdorferi, presents major health challenges worldwide, leading to serious neurological and musculoskeletal issues that impact patients' lives and healthcare systems. This systematic review and meta-analysis aim to determine the prevalence and link between Lyme disease and these complications, aiming to enhance clinical and public health approaches.

METHODS: We systematically searched PubMed, EMBASE, and Web of Science up until April 01, 2024, to find studies reporting the prevalence and severity of neurological and musculoskeletal complications associated with Lyme disease. Screening and data extraction were conducted using Nested Knowledge software. Two independent reviewers performed the quality assessment using the Newcastle-Ottawa Scale. Meta-analyses were performed using R software v4.3, employing a random-effects model.

RESULTS: Out of 3576 records, 17 studies were included, involving 3932 participants. These studies revealed significant prevalence of musculoskeletal symptoms (21.1%) and neurological disabilities (18%) among Lyme disease patients. The analysis showed a notable increase in risk for both complications in individuals with Lyme disease, with pooled Risk Ratios (RR) of 1.82 for musculoskeletal symptoms and 1.64 for neurological disabilities, indicating a significantly higher risk compared to control groups. Although heterogeneity across the studies was high, sensitivity analysis confirmed the consistency of our findings. Additionally, there was evidence of publication bias.

CONCLUSION: The study reveals significant neurological and musculoskeletal complications in Lyme disease patients, emphasizing the importance of early diagnosis, comprehensive treatment, and supportive care. The noted heterogeneity and potential publication bias highlight the need for transparent research and further study on long-term outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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