By SOURCE: JAMA Network Open; January 11, 2024 (Citations and Sources Below)

Key Points

Question  What is the seroprevalence of Rickettsia, Ehrlichia, and Galactose-α-1,3-galactose (α-gal) antibodies, and is exposure to these tick-borne diseases (TBDs) associated with chronic musculoskeletal symptoms?

Findings  In this cross-sectional study of 488 individuals, the weighted point prevalence was approximately 9% for Ehrlichia IgG, 17% for Rickettsia IgG, and 20% for α-gal IgE. Antibodies to these TBDs were not associated with symptomatic radiographic knee osteoarthritis, but individuals with elevated α-gal IgE levels reported higher rates of knee pain, aching, or stiffness.

Meaning  Findings from this study suggest that Ehrlichia or Rickettsia seropositivity was not associated with musculoskeletal symptoms but further investigation into the pathogenesis of α-gal syndrome is needed.

Importance  Tick-borne diseases (TBDs) other than Lyme disease, such as spotted fever group rickettsiosis, ehrlichiosis, and galactose-α-1,3-galactose (α-gal) syndrome, are an emerging public health issue. Long-term sequelae secondary to Ehrlichia or Rickettsia infection are uncommon; however, musculoskeletal symptoms are often attributed to prior tick exposure.

Objective  To evaluate the potential associations between prior exposure to TBDs and musculoskeletal symptoms, including radiographic osteoarthritis.

Design, Setting, and Participants  This cross-sectional study analyzed serum samples from the fourth visit (2017-2018) of the Johnston County Osteoarthritis (JoCo OA) project, an ongoing longitudinal, population-based study in Johnston County, North Carolina. Biospecimen testing and analysis were performed between May 2022 and November 2023. Participants in the JoCo OA project are noninstitutionalized White and Black Johnston County residents 45 years or older.

Main Outcome and Measures  The primary outcome was seropositivity with Ehrlichia IgG, Rickettsia IgG, and/or α-gal IgE and musculoskeletal symptoms. Secondary outcomes included risk factors associated with elevated α-gal IgE and weighted population point prevalence rates. Participants completed questionnaires, underwent physical assessments, and provided biospecimens for serological testing. Multivariable models were used to estimate associations of interest.

Results  Of the 605 participants who completed the fourth visit of the JoCo OA project, 488 (80.7%) had serum samples available for testing. The 488 participants had a median (IQR) age of 72 (68-78) years and included 336 females (68.9%) and 161 Black (33.0%) and 327 White (67.0%) individuals. The overall weighted point prevalence was 8.6% (95% CI, 5.9%-11.3%) for Ehrlichia IgG, 17.1% (95% CI, 12.6%-21.5%) for Rickettsia IgG, and 19.6% (95% CI, 15.3%-23.8%) for α-gal IgE level greater than 0.1 IU/mL. Only α-gal IgE was associated with knee pain, aching or stiffness (mean ratio, 1.30; 95% CI, 1.09-1.56). Antibodies to Rickettsia, Ehrlichia, and α-gal were not associated with symptomatic radiographic knee osteoarthritis. Male sex (odds ratio [OR], 2.63; 95% CI, 1.55-4.47), current smoker status (OR, 3.55; 95% CI, 1.38-9.18), and an attached tick bite in the past 5 years (OR, 3.99; 95% CI, 2.22-7.15) were all risk factors that were associated with α-gal IgE level greater than 0.1 IU/mL. Despite only 84 individuals (17.2%) recalling a tick bite in the past 5 years, 178 (36.5%) had evidence of prior tick-borne exposure, suggesting frequent human-tick interactions.

Conclusions and Relevance  Results of this cross-sectional study indicate no association between Ehrlichia or Rickettsia seropositivity and chronic musculoskeletal symptoms or osteoarthritis. Further investigation is needed into the pathogenesis of α-gal syndrome and interventions to reduce human-tick interactions.

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Citation: Zychowski DL, Alvarez C, Abernathy H, et al. Tick-Borne Disease Infections and Chronic Musculoskeletal Pain. JAMA Netw Open. 2024;7(1):e2351418. doi:10.1001/jamanetworkopen.2023.51418

SOURCE: JAMA Network Open; https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2813839