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Pediatric Lyme arthritis: clinical spectrum and outcome
C D Rose1, P T Fawcett, S C Eppes
1Division of Rheumatology, Alfred I. duPont Institute, Wilmington, Delaware 19899.
Insights
Pediatric Lyme arthritis presents diverse clinical patterns but resolves fully with antibiotic treatment. Early diagnosis and treatment in children lead to an excellent prognosis, even with varied presentations.
Area of Science:
- Pediatrics
- Rheumatology
- Infectious Diseases
Background:
- Lyme arthritis is a significant manifestation of Lyme disease in children.
- Understanding its clinical and serologic profiles is crucial for accurate diagnosis and management.
- Pediatric Lyme arthritis can mimic other forms of juvenile arthritis, complicating diagnosis.
Purpose of the Study:
- To evaluate the clinical and serologic profile of Lyme arthritis in a pediatric cohort.
- To assess treatment outcomes and prognosis for children diagnosed with Lyme arthritis.
Main Methods:
- A cohort of 44 children (ages 4-18) with confirmed Lyme arthritis (positive serology) was followed for 6-36 months.
- Clinical presentation, serologic findings, and treatment responses were documented.
- A comparison group of 34 children with juvenile rheumatoid arthritis or spondyloarthropathy was used for serologic comparison.
Main Results:
- Five distinct arthritis patterns were observed in the pediatric Lyme arthritis cohort.
- Erythema migrans preceded arthritis in seven children.
- Antinuclear antibodies were positive in 30% of patients.
- All patients achieved complete resolution of articular disease within 2-12 weeks with amoxicillin, doxycycline, or ceftriaxone treatment.
Conclusions:
- Lyme arthritis in children exhibits varied clinical and serologic features.
- Prompt antibiotic treatment leads to complete resolution and an excellent prognosis in pediatric Lyme arthritis.
- Lyme arthritis should be considered in the differential diagnosis of pediatric arthropathies.
Abstract:
A cohort of children with Lyme arthritis was used to evaluate the clinical and serologic profile of the disease. During a 42-month period (June 1989 to December 1991), 44 patients (13 girls and 31 boys, ages 4-18 years) were included and followed for 6-36 months. Inclusion required the presence of arthritis, as well as positive serology. Thirty-four children with juvenile rheumatoid arthritis or spondyloarthropathy were used as a serologic comparison group. Five different patterns of arthritis were found. Preceding erythema migrans was seen in seven children. Antinuclear antibodies were positive in 30% of the patients. Three treatments were used and selected according to physician preference, patient age, and presence of extraarticular disease: amoxicillin, doxycycline, and ceftriaxone. Articular disease reached complete resolution in all patients within 2-12 weeks. Lyme arthritis in children may mimic other pediatric arthritides. Prognosis for children with clearly defined Lyme arthritis was excellent.