What is the recommended treatment for arthralgia (joint pain) associated with tick-borne illnesses, such as Lyme disease?

From the Guidelines

The recommended treatment for arthralgia associated with tick-borne illnesses like Lyme disease is oral antibiotic therapy for 28 days, with doxycycline being the first-line treatment, as recommended by the Infectious Diseases Society of America 1. For adults, doxycycline is usually prescribed at 100 mg twice daily. Alternative antibiotics include amoxicillin (500 mg three times daily) or cefuroxime axetil (500 mg twice daily) for similar durations, particularly for pregnant women or children under 8 years old who shouldn't take doxycycline. Some key points to consider in the treatment of Lyme disease include:

• The use of doxycycline, amoxicillin, or cefuroxime axetil as first-line oral agents for the treatment of early Lyme disease, with doxycycline being the preferred choice due to its effectiveness against HGA 1.
• The recommended duration of antibiotic therapy for Lyme arthritis is 28 days, as stated in the 2020 guidelines by the Infectious Diseases Society of America, American Academy of Neurology, and American College of Rheumatology 1.
• The importance of rest, gentle stretching, and avoiding overexertion of affected joints during recovery, as well as the use of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen for symptom relief.
• In cases of persistent arthralgia despite appropriate antibiotic therapy, a second course of antibiotics may be considered, or referral to a rheumatologist for further evaluation, with options including symptomatic therapy with NSAIDs, intra-articular injections of corticosteroids, or arthroscopic synovectomy 1.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain effectiveness of doxycycline hyclate and other antibacterial drugs, doxycycline hyclate should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Doxycycline is indicated for the treatment of the following infections: Rocky Mountain spotted fever, typhus fever and the typhus group, Q fever, rickettsialpox, and tick fevers caused by Rickettsiae. Relapsing fever due to Borrelia recurrentis.

The recommended treatment for arthralgia (joint pain) associated with tick-borne illnesses, such as Lyme disease, is doxycycline.

• Doxycycline is indicated for the treatment of relapsing fever due to Borrelia recurrentis. However, the label does not explicitly mention Lyme disease or arthralgia as an indication for doxycycline, but Borrelia is a genus of tick-borne bacteria that includes the species that causes Lyme disease 2.

From the Research

Treatment Options for Arthralgia Associated with Tick-Borne Illnesses

The treatment for arthralgia (joint pain) associated with tick-borne illnesses, such as Lyme disease, depends on the stage and severity of the disease.

• For early stages of Lyme disease, oral antibiotics such as amoxicillin (500 mg 3 or 4 times daily) with or without probenecid 500 mg 3 times daily, doxycycline (100 mg twice daily), or tetracycline (500 mg 4 times daily) are recommended for 3 to 4 weeks 3.
• For later stages of Lyme disease, including arthritis, treatment with 2 to 3 weeks of intravenous antibiotics such as cefotaxime (3 g every 12 hours), ceftriaxone (1 g every 12 hours or 2 g every day), and benzylpenicillin (14 g in divided doses) is recommended 3.
• Studies have shown that oral doxycycline and parenteral ceftriaxone are equally effective in preventing late manifestations of Lyme disease, including arthritis 4.
• Mild arthralgia is a common residual symptom after treatment, but it usually resolves on its own 4, 5.

Special Considerations

• Patients with isolated facial seventh cranial nerve palsy may be treated with oral therapy, but some physicians may prescribe concomitant corticosteroids to hasten the resolution of the palsy 3.
• Children under 8 years old with Lyme disease can be treated with doxycycline, which is generally well-tolerated and effective, but alternative antibiotics like amoxicillin are still preferred for non-neurological manifestations 6.
• In some cases, patients with chronic symptoms of Lyme disease may require intravenous ceftriaxone treatment 7.