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Updated: Jun 5, 2026
04:41
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Lyme arthritis in children presenting with joint effusions
Matthew D Milewski1, Aristides I Cruz, Christopher P Miller
1Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT 06520-8071, USA. mdmilewski@gmail.com
The Journal of Bone and Joint Surgery. American Volume
|January 27, 2011
Summary
Lyme arthritis affects 31% of children with joint effusions in endemic areas. Refusal to bear weight is a key indicator differentiating it from septic arthritis in pediatric patients.
Area of Science:
- Pediatric Rheumatology
- Infectious Diseases
- Orthopedic Surgery
Background:
- Lyme arthritis is a significant concern in children residing in or visiting endemic regions.
- Differentiating Lyme arthritis from septic arthritis is crucial for appropriate and timely treatment in pediatric patients.
Purpose of the Study:
- To determine the prevalence of Lyme arthritis in children undergoing joint aspiration at a tertiary care hospital.
- To identify clinical factors that help distinguish Lyme arthritis from septic arthritis upon initial presentation.
Main Methods:
- Retrospective review of joint aspirations in children (≤18 years) from 1992-2009.
- Analysis of aspirate cell counts, cultures, inflammatory markers, and surgical interventions.
- Comparison of clinical presentation between Lyme arthritis and septic arthritis cohorts.
Main Results:
- 31% of 391 pediatric patients with joint effusions were diagnosed with Lyme arthritis.
- Significant differences observed in fever, weight-bearing ability, and white blood cell/joint fluid counts between Lyme and septic arthritis.
- Refusal to bear weight was the strongest predictor for septic arthritis over Lyme arthritis.
Conclusions:
- Lyme arthritis prevalence is 31% overall and 45% for knee effusions in endemic areas.
- Children with Lyme arthritis are more prone to knee involvement, lower cell counts, and less likely to have fever or refuse weight-bearing compared to septic arthritis.
- Clinical factors like weight-bearing status and cell counts aid in differentiating pediatric Lyme arthritis from septic arthritis.
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