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Pediatric Antibiotic-refractory Lyme Arthritis: A Multicenter Case-control Study.
Daniel B Horton1,2, Alysha J Taxter3,4, Amy L Davidow3,4
1From the Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey; Department of Biostatistics - Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey; Department of Pediatrics, Brenner Children's Hospital, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina; Department of Pediatrics, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Pediatrics, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University, Wilmington, Delaware. daniel.horton@rutgers.edu.
Older children with prolonged Lyme arthritis, especially in the knee, are at higher risk for antibiotic-refractory Lyme arthritis (ARLA). Prompt anti-inflammatory treatment is recommended for persistent cases.
Area of Science:
- Pediatric Rheumatology
- Infectious Diseases
- Lyme Disease Research
Background:
- Antibiotic-refractory Lyme arthritis (ARLA) presents a clinical challenge in pediatric rheumatology.
- Identifying factors associated with ARLA is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify clinical and treatment factors associated with pediatric antibiotic-refractory Lyme arthritis (ARLA).
Main Methods:
- A case-control study was conducted in three pediatric rheumatology clinics.
- Cases included children with persistent arthritis despite antibiotic treatment; controls had resolved arthritis.
- Logistic regression analyzed demographic, clinical, and treatment factors.
Main Results:
- Older age (≥10 years), prolonged arthritis at diagnosis, knee-only arthritis, and initial worsening predicted ARLA.
- Fever, severe pain, and systemic inflammation signs correlated with better treatment response.
- Low-dose amoxicillin and nonadherence increased ARLA risk; ARLA cases had more adverse events and hospitalizations.
Conclusions:
- Older children with prolonged or knee-limited Lyme arthritis, or poor initial response, face higher ARLA risk and toxicity.
- Children with systemic inflammation symptoms show better outcomes.
- Consider anti-inflammatory treatment and rheumatology referral for persistent Lyme arthritis after two antibiotic courses.
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