Joint Recruitment – A Phenomenon of New-Onset Arthritis Following Initiation of Antibiotic Treatment for Lyme Arthritis
Notice bibliographique
Résumé
Objectives Lyme arthritis (LA), a manifestation of late disseminated Lyme disease (LD), is a common presentation of LD in children.[1] A complete response to 1-2 courses of antibiotics occurs in most patients; however, 10-15% can have persistent arthritis in the presenting joint(s), termed post-infectious LA.[2] Another phenomenon, which has been called “joint recruitment,” describes new-onset arthritis in a joint(s) after antibiotic therapy has been initiated or completed.[3] The objectives of this study were to describe the incidence and clinical course of joint recruitment in a cohort of children with LA. Methods Patients (<18 yo) with a diagnosis of LA (Jan 2008-Sept 2023) were identified from the pediatric rheumatology clinical database at IWK Health in Halifax, Nova Scotia. Medical charts were reviewed and those who experienced new onset arthritis beyond the presenting joint(s), following initiation of antibiotic therapy, were identified. Descriptive statistics are described. Results Of 245 patients, the incidence of joint recruitment was 5.7%; 9 males/5 females with a mean age of 11.9 years (range 4-16). All patients were initially treated with a standard course of 28 days of oral antibiotics. In 13/14 (93%) a single knee was the presenting joint. In 11/14 cases (79%), 1 joint was recruited (6 knee, 3 elbow, 1 wrist, 1 shoulder). Timeline varied from within a few days of starting the first course of antibiotics to following 2 months of oral and/or IV antibiotics (Figure 1). When joint recruitment occurred, the presenting joint with arthritis had resolved or improved in 9/14 (64%). 8/14 (57%) received another course of antibiotics at the time of joint recruitment; treatment for the remainder was variable (intraarticular steroid injection (IAS), NSAID, observation, synovectomy). All patients had complete resolution of their LA at last follow-up, except for 1 patient who, 6 months from initiation of antibiotics, continues to have ongoing arthritis in both the presenting joint and recruited joint following 3 months of antibiotics (2 courses oral, 1 course ceftriaxone) and IAS of affected joints (knee, ankle). Figure 1. Representation of Timing of Joint Recruitment Conclusion The study aims to raise awareness around atypical cases of LA in children. To our knowledge, this is the first study to report the incidence (5.7%) of joint recruitment. Overall, patients had excellent outcomes despite different treatment approaches. It is unclear as to whether joint recruitment is driven by persistent active infection versus immune dysregulation triggered by infection, the latter hypothesized to be the underlying mechanism of post-infectious LA. [1.] Ogden N. Ticks Tick Borne Dis 2020;11(2):101347. [2.] Arvikar SL. Infect Dis Clin North Am 2015;29(2):269-80. [3.] Horton D. J Rheumatol 2019;46(8):943-51.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».