From the Guidelines
Treatment for arthritis due to Lyme disease should involve oral antibiotic therapy for 28 days, as recommended by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR) 1. The standard antibiotic regimen is doxycycline 100mg twice daily for 28 days. Alternative antibiotics include amoxicillin 500mg three times daily or cefuroxime 500mg twice daily for the same duration. For children or pregnant women, amoxicillin is preferred. For symptom relief, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (400-800mg three times daily) or naproxen (500mg twice daily) can reduce joint pain and swelling. In severe cases that don't respond to oral antibiotics, intravenous ceftriaxone 2g daily for 14-28 days may be necessary 1. Some patients develop post-infectious arthritis that persists after the infection is cleared; these cases may require disease-modifying antirheumatic drugs (DMARDs) like hydroxychloroquine or methotrexate. Physical therapy can help maintain joint function and range of motion. Early treatment is crucial as prolonged infection increases the risk of persistent arthritis. Patients should complete the full course of antibiotics even if symptoms improve before completion to ensure complete eradication of the bacteria. It is also important to note that for patients with persistent or recurring nonspecific symptoms following standard treatment, additional antibiotic therapy is not recommended 1. Key considerations in treatment include:
- Duration of antibiotic therapy: 28 days for oral antibiotics 1
- Choice of antibiotic: doxycycline, amoxicillin, or cefuroxime 1
- Management of symptoms: NSAIDs for pain and swelling 1
- Consideration of post-infectious arthritis and the potential need for DMARDs 1
From the Research
Treatment Options for Arthritis due to Lyme Disease
- The mainstay of initial treatment is a prolonged course of oral antibiotics 2
- Intravenous antibiotics, such as ceftriaxone, may be used in cases where oral antibiotics are not effective 3, 4, 5
- Doxycycline and amoxicillin are commonly used oral antibiotics for treating Lyme arthritis, with doxycycline having a response rate of 90% and amoxicillin having a response rate of 89% 3, 5
- Intravenous ceftriaxone has been shown to be superior to penicillin with a response rate of 94% 3
- Amoxicillin (1.5 g/day), azithromycin (0.5 g/day), injectable ceftriaxone, and injectable cefotaxime were found to be effective for treating Lyme disease in a network meta-analysis 6
Duration of Treatment
- The typical duration of oral antibiotic treatment is 3 to 4 weeks 4
- Longer duration therapy has never been evaluated and therefore is not currently indicated 4
- However, some studies suggest that longer-term antibiotic therapy may be useful for eradicating the sanctuaries of Borrelia burgdorferi 3
Special Considerations
- Patients with certain genetic and immune markers, such as HLA-DR4 specificity and OspA reactivity, may have persistent arthritis despite treatment with oral or intravenous antibiotics 5
- Neuroborreliosis may develop in some patients, even after successful treatment of Lyme arthritis 3, 5
- Disease-modifying drugs, such as hydroxychloroquine or sulphasalazine, may be of value in Lyme arthritis resistant to antibiotics, but have not been tested to date 3