Treatment of Lyme Arthritis

Infection with the tick-borne spirochete Borrelia burgdorferi leads to an estimated 300,000 new cases annually of Lyme disease in the United States. The northeastern United States is the most affected region, but the infection is also found in mid-Atlantic states, the upper Midwest, and in California1, and it now extends into Canada2. Lyme borreliosis in also endemic in parts of Europe and Asia1. In untreated patients, the infection generally occurs in stages, with different manifestations at each stage3. The disease usually begins with an expanding skin lesion, erythema migrans, accompanied by flu-like symptoms. Weeks later, untreated patients may have neurologic involvement, characterized by lymphocytic meningitis, cranial neuropathy, or radiculoneuropathy, or they may develop carditis, frequently manifested as atrioventricular nodal block. These manifestations of the disease can usually be treated successfully with appropriate antibiotic therapy for 2–4 weeks4. In North America, arthritis is the most common late manifestation of Lyme disease5. Lyme arthritis (LA) typically begins months after the initial tick exposure, and without antibiotic treatment, it often causes intermittent or persistent, monoarticular or oligoarticular arthritis, usually in 1 or 2 joints at a time, especially the knees, over a period of several years. Tendons, ligaments, or bursae may also be affected. Because early Lyme disease is usually recognized and treated effectively with antibiotic therapy, LA is typically seen now only in patients with minimal or no symptoms of early infection. Such patients present with arthritis at any time of the year, not only in the summer. Both children and adults are affected. Patients with LA generally have the highest IgG antibody responses seen in Lyme disease, as determined by ELISA, with expansion of the response to many spirochetal proteins, as shown by Western blotting. Similar to the experience … Address correspondence to Dr. A.C. Steere, Massachusetts General Hospital, 55 Fruit St., Boston, Massachusetts 02114, USA. E-mail: asteere{at}partners.org

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