Joint Recruitment – A Phenomenon of New-Onset Arthritis Following Initiation of Antibiotic Treatment for Lyme Arthritis
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".