From the Guidelines
Prednisone should not be used as the first-line treatment for Lyme arthritis pain, and instead, a course of antibiotics such as doxycycline or amoxicillin should be prioritized. The primary treatment for Lyme arthritis is a 28-day course of oral antibiotic therapy, as recommended by the Infectious Diseases Society of America (IDSA) 1. For pain management during treatment, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are preferred first options.
Key Considerations
- Prednisone (typically 5-20mg daily) should only be considered for severe inflammatory symptoms when antibiotics and NSAIDs aren't providing adequate relief, and only under close medical supervision 1.
- Using corticosteroids like prednisone without appropriate antibiotic coverage may actually worsen Lyme disease by suppressing the immune response needed to fight the infection.
- Other non-medication options include rest, joint protection, physical therapy, and applying heat or cold to affected joints.
- It's essential to complete the full course of antibiotics even if symptoms improve, as incomplete treatment can lead to persistent infection and chronic arthritis.
Treatment Options
- Doxycycline (100mg twice daily for 28 days) or amoxicillin (500mg three times daily for 28 days) are recommended antibiotic regimens for the initial treatment of Lyme arthritis 1.
- For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of intravenous ceftriaxone may be considered 1.
From the FDA Drug Label
The initial dosage of PredniSONE tablets may vary from 5 mg to 60 mg per day, depending on the specific disease entity being treated. The FDA drug label does not answer the question.
From the Research
Treatment Options for Lyme Arthritis
- The mainstay of initial treatment for Lyme arthritis is a prolonged course of oral antibiotics 2, 3, 4, 5, 6.
- Doxycycline is recommended for late Lyme arthritis, although amoxicillin or ceftriaxone may be considered 3, 6.
- For patients with persistent arthritis despite previous oral antibiotics or parenteral penicillin, intravenous ceftriaxone for 2 weeks may be given 3.
- Approximately 10% of patients have persistent arthritis despite antimicrobial therapy, termed postinfectious Lyme arthritis, which is thought to be related to prolonged inflammation and unique microbial and host interaction 6.
- Therapy at this stage relies on immunosuppression and/or synovectomy 6.
Use of Prednisone for Lyme Arthritis
- There is no direct evidence in the provided studies to support the use of prednisone for Lyme arthritis pain.
- However, immunosuppression is mentioned as a treatment option for postinfectious Lyme arthritis, which may involve the use of corticosteroids like prednisone 6.
Other Treatment Considerations
- The diagnosis of Lyme disease is based on clinical manifestations and adjunctive laboratory testing 4, 5.
- Serologic testing is the mainstay of diagnosis for Lyme arthritis 5.
- Synovial fluid polymerase chain reaction for B burgdorferi DNA is often positive before treatment, but is not a reliable marker of spirochetal eradication after therapy 5.