Lyme disease: why the recommendations of the High Authority of health enven the debate

2018-07-11T13: 38: 23.181Z – Mathilde Roche

Recognizing June 20 the existence of "persistent and unexplained" symptoms in patients who claim to be victims of the disease of Lyme, the High Authority of Health (HAS) said to want to "exceed" the polemics on the subject. This is missed given the reactions. This infectious disease, also called Lyme borreliosis, is caused by a bacterium and transmitted by a tick bite. It "is diagnosed by a clinical examination first and foremost", and if necessary by blood tests. But the lack of knowledge about its development and treatment makes it a subject of controversy between patient badociations and the medical profession. This is why the HAS wanted to "propose a solution to everyone" with official recommendations. If the recommendations of this independent authority were highly anticipated by the patients, they were mostly poorly received by health professionals.

In its recommendations, the HAS groups situations of "patients who may have been exposed to ticks and who present polymorphic, persistent and unexplained clinical signs, which may be disabling" under a new and broad term: "symptomatology / syndrome persistent polymorphic after possible tick bite "(SPPT), all accompanied by the modalities of care.

The first institution to react was the learned society of infectiology (Spilf). She refused to validate the text of HAS, declaring in a statement that "this ill-defined set of symptoms does not exist in the international medical literature and could lead to over-diagnosis that may lead patients to inadequate care".

the Academy of Medicine, this term SPPT has absolutely no reason to be.In a statement dated July 2, the institution expressed "its deep d reception "face these official recommendations. For her, the HAS "recognizes implicitly the existence of such a pathology without the slightest proof with, as a consequence, proposals for heavy management involving numerous investigations, expensive and often unnecessary". In his eyes, "far from clarifying the situation," the HAS, in "wanting to please everyone, does not satisfy anyone."

The National College of Teaching General Practitioners (CNGE) has joined this opinion of the Academy of Medicine in publishing a reaction on Tuesday. "In the expectation of the opinion argued on the merits of its scientific council", the CNGE advises in this release to all doctors "to ignore" the official recommendations in the treatment of Lyme disease. Indeed, "in the current state of science, it does not rely on any valid scientific data." The College in turn evokes a risk "to lead to an escalation of complementary examinations (…), to expose patients to an important iatrogenic [effets indésirables des  médicaments] "in the end," to solve nothing of their problems. "This recommendation on this SPPT 'possibly without any evidence of tick bite' illustrates the" drifts "of the method of elaboration of the recommendations of the HAS in general medicine, estimates the College.

In its recommendations, the HAS wishes Moreover, an "optimal overall therapeutic management of patients with or suspected of having a tick-borne disease, in order to respond to the suffering of patients, some of whom feel themselves victims of denial or rejection, and to avoid diagnostic and therapeutic wandering and its potential drift. "If the risk is indeed a" use of tests and inappropriate treatments, not validated and potentially at risk of side effects ", the High Health Authority believes that" even if the Scientific uncertainties are real, all patients must be supported and heard in their suffering. "

But these recommendations put back on the front of the sc no claims of some badociations for the recognition of chronic forms of the disease. The HAS did not give them this time but provided a description: "People who have been potentially exposed to ticks" who "have various clinical signs (muscle pain, headaches, fatigue, cognitive disorders), persistent, generally diffuse, unexplained, potentially disabling ". The Academy of Medicine sees there a "blackmail of pressure groups" and "misinformation campaigns led by the proselytes of the doctrines of an American badociation, the ILADS (International Lyme and Associated Diseases Society)."

One of the patients' badociations, ChroniLyme, believes that the recommendations of the HAS are equivalent to "the recognition of a possibly chronic Lyme". As for the negative reaction of the Academy of Medicine, it "translates the first stinging defeat of the camp of denial", judged the badociation on Twitter.

Mathilde Roche

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