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Prolonged synovitis in pediatric Lyme arthritis cannot be predicted by clinical or laboratory parameters

AnneMarie C Brescia1, Carlos D Rose, Paul T Fawcett

  • 1Division of Rheumatology, AI duPont Hospital for Children, Wilmington, DE 19803, USA. abrescia@nemours.org

Clinical Rheumatology
|February 6, 2009
PubMed

Insights

Many children with Lyme arthritis (LA) experience prolonged synovitis. This study found no predictors for disease duration in pediatric LA patients, indicating treatment delay, age, or seroreactivity do not influence recovery time.

Area of Science:

  • Pediatric Rheumatology
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Lyme arthritis (LA) can persist in 10% of patients despite antibiotic treatment.
  • Understanding the natural history and predictors of prolonged pediatric LA is crucial for effective management.

Purpose of the Study:

  • To identify predictors of prolonged disease in pediatric Lyme arthritis.
  • To further define the natural history of Lyme arthritis in children.

Main Methods:

  • Retrospective review of medical records for 94 pediatric patients meeting CDC criteria for Lyme disease.
  • Classification of patients based on the duration of synovitis.
  • Statistical analysis using SPSS, including Pearson correlation, parametric, and nonparametric tests, linear and logistic regression.

Main Results:

  • 39% of pediatric LA patients required over 6 months for synovitis resolution; 13% required over 12 months.
  • No significant correlation was found between pre-treatment symptom duration and synovitis duration.
  • No significant differences in age, antinuclear antibody positivity, ELISA titer, or Western blot reactivity were identified between groups.
  • Linear and logistic regression analyses did not reveal any predictors for disease duration.

Conclusions:

  • Approximately one-third of pediatric Lyme arthritis cases experience prolonged synovitis lasting over 6 months.
  • Disease duration in pediatric LA is not associated with delayed treatment, patient age, or serological reactivity.

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