Children with Lyme arthritis have an excellent prognosis. Treatment of patients who have antibiotic-refractory Lyme arthritis with NSAIDs, intra-articular corticosteroid injections, or disease-modifying antirheumatic drugs (DMARDs) is safe and effective, with no evidence of chronic arthritis, permanent joint changes, or breakthrough cases of persistent infection.
Tory and associates examined outcomes in 99 children with Lyme arthritis, most of whom had monarticular involvement of the knee. The children were treated according to recommendations from the American Academy of Pediatrics and the Infectious Diseases Society of America—no more than two 28-day courses of oral antibiotics and one 28-day course of intravenous antibiotics, followed by nonantimicrobial therapy.
In all, 76 children responded to the antibiotics. Among the 23 who did not, response was excellent in 6 who were treated with NSAIDs, 4 who received intra-articular corticosteroids, and 2 for whom DMARDs were prescribed. Six children received additional antibiotics; half then needed DMARDs, and the others had spontaneous remission. Five children were lost to follow-up.
The authors noted that although further attempts to optimize the treatment of children with Lyme arthritis are indicated, significant deviations from current treatment recommendations do not appear to be warranted.
