From the Guidelines
Lyme serology testing is recommended for patients with joint symptoms suspected to be related to Lyme disease, using a two-tier testing method consisting of an enzyme-linked immunoassay or immunofluorescence assay, followed by Western blot confirmation if the first test is positive or equivocal, as supported by the Infectious Diseases Society of America guidelines 1. The diagnosis of Lyme disease is typically based on clinical presentation and laboratory testing. For patients with Lyme arthritis, which typically presents as recurrent episodes of joint swelling (especially in the knee), serologic testing usually shows high antibody titers. Some key points to consider in the diagnosis and treatment of Lyme disease include:
- The use of a two-tier testing method for serologic testing, which includes an enzyme-linked immunoassay or immunofluorescence assay, followed by Western blot confirmation if the first test is positive or equivocal 1.
- The importance of clinical correlation in interpreting serologic test results, as false positives can occur in patients with other inflammatory or autoimmune conditions 1.
- The recommended treatment for Lyme arthritis, which includes doxycycline 100mg twice daily for 28 days in adults, or amoxicillin 500mg three times daily for 28 days for children or those who cannot take doxycycline, with alternative regimens including cefuroxime axetil 500mg twice daily for 28 days 1.
- The potential for patients to develop persistent synovitis despite appropriate antibiotic therapy, which may represent a post-infectious inflammatory response rather than ongoing infection, and may require anti-inflammatory treatments 1.
From the Research
Lyme Serology Joint
- Lyme disease is a multisystem inflammatory disease caused by infection with Borrelia burgdorferi, and its later features include arthritis and neurological disease which can occur weeks to years after the onset of the illness 2.
- The efficacy of different therapeutic regimens for Lyme arthritis has been reviewed, and intravenous ceftriaxone has been shown to be superior to penicillin with a response rate of 94% 3.
- Lyme arthritis can usually be treated successfully with oral antibiotics, but patients may still develop neuroborreliosis, and patients with certain genetic and immune markers may have persistent arthritis despite treatment with oral or intravenous antibiotics 4.
- Guidelines for the diagnosis and treatment of Lyme arthritis recommend oral antibiotic treatment, with doxycycline being the antibiotic agent of choice, and patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously with ceftriaxone 5.
- Lyme arthritis typically presents as a monoarthritis or oligoarthritis in large joints such as the knee, and accompanying positive 2-tier Lyme serologies or polymerase chain reaction from synovial fluid/tissue is considered diagnostic for patients from an endemic area 6.
Treatment Options
- Oral doxycycline or amoxicillin in association with probenecid seems to work equally well for Lyme arthritis, although neuroborreliosis was more frequent following treatment with amoxicillin 3.
- Intravenous ceftriaxone is recommended for patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy 5.
- There is no evidence to recommend long-term and combined treatments for Lyme arthritis 5.
Diagnosis
- A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot for the diagnosis of Lyme arthritis 5.
- A positive PCR test from synovial fluid adds increased diagnostic certainty 5.
- Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment 5.