Outcomes of Children Treated for Lyme Arthritis
By Linda on May 12, 2010 in Infections | comments(0)
Excerpt:
OBJECTIVE: Children often develop arthritis secondary to Lyme
disease; however, optimal treatment of Lyme arthritis in
pediatric patients remains ill-defined.
We sought to characterize the outcomes of a large cohort of
children with Lyme arthritis treated using the approach
recommended by the American Academy of Pediatrics and the
Infectious Diseases Society of America. METHODS: Medical records
of patients with Lyme arthritis seen by rheumatologists at a
tertiary care children’s hospital from 1997 to 2007 were
reviewed. Patients were classified with antibiotic responsive or
refractory arthritis based on absence or presence of persisting
joint involvement 3 months after antibiotic initiation. Treatment
regimens and outcomes in patients with refractory arthritis were
analyzed.RESULTS: Of 99 children with Lyme arthritis, 76 had arthritis
that responded fully to antibiotics, while 23 developed
refractory arthritis. Most patients with refractory arthritis
were successfully treated with nonsteroidal antiinflammatory
drugs (6 patients), intraarticular steroid injections (4), or
disease-modifying antirheumatic drugs (DMARD) (2). Five were lost
to followup. Six patients with refractory arthritis were
initially treated elsewhere and received additional antibiotic
therapy, with no apparent benefit.
Three subsequently required DMARD, while 3 had gradual resolution
of arthritis without further therapy. Antibiotic responsiveness
could not be predicted from our clinical or laboratory data.CONCLUSION: Lyme arthritis in children has an excellent
prognosis. More than 75% of referred cases resolved with
antibiotic therapy. Of patients with antibiotic refractory
arthritis, none in whom followup data were available developed
chronic arthritis, joint deformities, or recurrence of infection,
supporting current treatment guidelines.
