The Impact of Operative Intervention in Pediatric Lyme Arthritis

Area of Science:

• Pediatric Orthopedics
• Infectious Disease Epidemiology
• Rheumatology

Background:

• Lyme arthritis in children can mimic septic arthritis, leading to diagnostic challenges.
• Distinguishing Lyme arthritis from septic arthritis is crucial for appropriate treatment, as Lyme arthritis is managed with antibiotics while septic arthritis often requires surgery.
• Increased Lyme disease prevalence in regions like Western Pennsylvania has led to more pediatric patients undergoing operative intervention for undifferentiated arthritis.

Purpose of the Study:

• To evaluate the impact of operative intervention on pediatric Lyme arthritis outcomes.
• To compare the efficacy and resource utilization of antibiotic therapy alone versus combined antibiotic and operative debridement for pediatric Lyme arthritis.

Main Methods:

• Retrospective cohort study of 149 pediatric patients diagnosed with Lyme arthritis between 2008 and 2018.
• Inclusion criteria included positive Lyme serology (CDC definition), clinical arthritis, and negative bacterial cultures.
• Patients were divided into nonoperative (antibiotics only) and operative (antibiotics plus surgery) groups for comparison of hospitalization details, costs, and outcomes.

Main Results:

• Of 149 patients, 47 (32%) underwent orthopedic intervention.
• Operative management was linked to longer hospital stays (3.17 vs. 1.40 days) and higher costs ($27,850 vs. $10,716).
• Clinical resolution occurred in 98% of both nonoperative (57/58) and operative (41/42) groups, with a median resolution time of 21 days for both.

Conclusions:

• Operative management for pediatric Lyme arthritis increases resource use and costs without offering superior clinical outcomes compared to nonoperative management.
• Improved diagnostic strategies for acute undifferentiated arthritis are needed to prevent unnecessary surgical interventions as the Lyme disease epidemic grows.
• Nonoperative management with antibiotics is as effective as surgery for pediatric Lyme arthritis, highlighting the need for careful diagnostic evaluation.