Diagnosis and treatment of Lyme arthritis

Abstract

Lyme disease is a multisystem disease that affects primarily skin, nervous system, heart and joins. Lyme disease is caused by Borrelia burgdorferi and spread by Ixodes ticks. Arthritis is a well-known manifestation of Lyme disease (LD). Joint symptoms associated with B. burgdorferi infection range from arthralgias, to brief attacks of arthritis, to chronic erosive synovitis. Arthritis may present as oligo- or monoarthritis and typically causes intermittent attacks of oligoarticular arthritis in a few large joints, especially the knee. A small percentage of patients may develop chronic 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. Spirochetal DNA may be detected in joint fluid by PCR. Antibiotic treatment during early stages normally prevents development of late manifestations. Joint involvement is treated successfully with a 1-month course of doxycycline or ceftriaxone. However, about 10% of Lyme arthritis patients do not respond sufficiently to antibiotic treatment. If patients have persistent arthritis despite a second course of antibiotics with negative results of PCR testing, treatment with anti-inflammatory agents or arthroscopic synovectomy is possible. In this article, we discuss clinical features, diagnosis and treatment.