From the Guidelines
Lyme arthritis is a late manifestation of Lyme disease characterized by joint inflammation, typically affecting large joints, especially the knee, and should be treated with a 28-day course of oral antibiotics, as recommended by the most recent guidelines 1.
Key Characteristics of Lyme Arthritis
- Typically affects large joints, especially the knee
- Caused by the Borrelia burgdorferi bacteria triggering an inflammatory response in the joints
- May persist even after the infection has been cleared due to autoimmune mechanisms
Treatment Recommendations
- Oral antibiotic therapy for 28 days is the preferred initial treatment for Lyme arthritis, with doxycycline (100mg twice daily) being the first-line choice for adults 1
- Alternatives include amoxicillin (500mg three times daily) or cefuroxime axetil (500mg twice daily)
- For children, amoxicillin (50mg/kg/day divided into three doses) is preferred, with doxycycline appropriate for those over 8 years old
- In cases that don't respond to oral antibiotics, intravenous ceftriaxone (2g daily for adults) for 14-28 days may be necessary 1
Management of Persistent Symptoms
- Nonsteroidal anti-inflammatory drugs can help manage pain and inflammation during treatment
- Additional antibiotic therapy is not recommended for patients with persistent nonspecific symptoms following standard treatment, unless there is objective evidence of reinfection or treatment failure 1
- In patients with Lyme arthritis with partial response to initial treatment, a second course of oral antibiotics or observation may be considered, while those with no or minimal response may benefit from a 2-4 week course of IV ceftriaxone 1
From the Research
Definition and Causes of Lyme Arthritis
- Lyme arthritis is a manifestation of Lyme disease, a multisystem disease caused by the bacterium Borrelia burgdorferi, which is spread by Ixodes ticks 2, 3, 4, 5, 6.
- The disease can affect various parts of the body, including the skin, nervous system, heart, and joints 2, 3.
Clinical Features of Lyme Arthritis
- Joint symptoms associated with B. burgdorferi infection can range from arthralgias to brief attacks of arthritis, and even chronic erosive synovitis 2.
- Arthritis may present as oligo- or monoarthritis, typically causing intermittent attacks of oligoarticular arthritis in a few large joints, especially the knee 2, 4.
- A small percentage of patients may develop chronic arthritis 2.
Diagnosis of Lyme Arthritis
- The diagnosis is usually based on the clinical picture, exposure in an endemic area, and detection of IgG antibody against B. burgdorferi by ELISA and Western blotting 2, 4, 6.
- Spirochetal DNA may be detected in joint fluid by PCR, which can add increased diagnostic certainty 2, 4.
Treatment of Lyme Arthritis
- Antibiotic treatment during early stages normally prevents the development of late manifestations, including arthritis 2, 3, 4, 5.
- Joint involvement is typically treated successfully with a 1-month course of doxycycline or ceftriaxone 2, 4, 5.
- For patients who do not respond sufficiently to antibiotic treatment, treatment with anti-inflammatory agents or arthroscopic synovectomy may be considered 2, 5, 6.