Pediatric Lyme Arthritis: Clinical Spectrum and Outcome

Rosé, Carlos D.; Fawcett, Paul T.; Eppes, S C; Klein, Joel D.; Gibney, Kathleen M.; Doughty, Robert A.

doi:10.1097/01241398-199403000-00020

Cited by 35 publications

(11 citation statements)

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“…Rose et al 32 described five common patterns of Lyme arthritis in children. Classic arthritis is characterized by episodic synovitis with involvement of one to four joints lasting <1 week, separated by asymptomatic periods of ≥2 weeks.…”

Section: Late Lyme Disease and Arthritismentioning

confidence: 99%

“…The acute pauciarticular form is defined by continual involvement of one to four joints for <4 weeks. 32 This form is also called “pseudoseptic” because of its similarity to acute bacterial septic arthritis. Classic arthritis and acute pauciarticular arthritis were the most common forms in the series by Rose et al 32 The other three forms of arthritis (ie, chronic pauciarticular, migratory, polyarticular) most closely resembled other pediatric rheumatologic disease, such as juvenile idiopathic arthritis.…”

Section: Late Lyme Disease and Arthritismentioning

confidence: 99%

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Lyme Disease and the Orthopaedic Implications of Lyme Arthritis

Smith

Cruz

Milewski

et al. 2011

American Academy of Orthopaedic Surgeon

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Lyme disease is the most common tick-borne disease in the United States and Europe. Increased awareness of the clinical manifestations of the disease is needed to improve detection and treatment. In the acute and late stages, Lyme disease may be difficult to distinguish from other disease processes. The epidemiology and pathophysiology of Lyme disease are directly related to the Borrelia burgdorferi spirochete and its effects on the integumentary, neurologic, cardiac, and musculoskeletal systems. Lyme arthritis is a common clinical manifestation of Lyme disease and should be considered in the evaluation of patients with monoarticular or pauciarticular joint complaints in a geographic area in which Lyme disease is endemic. Management of Lyme arthritis involves eradication of the spirochete with antibiotics. Generally, the prognosis is excellent. Arthroscopic synovectomy is reserved for refractory cases that do not respond to antibiotics.In 1977, Steere et al1 described a mysterious arthritis epidemic that affected 39 children and 12 adults in three contiguous communities in Connecticut. The illness was characterized by recurrent attacks of asymmetric swelling and pain in large joints. The knee was the most common site of involvement. Early cases in children were misdiagnosed as juvenile rheumatoid arthritis; however, the geographic clustering of cases indicated an infectious etiology. This previously unrecognized entity was dubbed Lyme arthritis after the town of Lyme, Connecticut, where most of the first known patients lived.The initial work of Steere et al 1 pointed toward an arthropod as the likely vector of transmission of Lyme arthritis because of the geographic clustering of the affected patients in sparsely settled, heavily wooded areas along the Connecticut shore and because the peak incidence occurred during the summer months. This hypothesis was supported by the presence of an expanding skin lesion, 1 to 24 weeks before the onset of arthritis, that was similar to erythema migrans. At the time, a vector-borne illness was the suspected etiology of erythema migrans. 2 Subsequent investigations into the etiology of Lyme arthritis led to the discovery of the causative agent, Borrelia burgdorferi, a spirochetal organism that is transmitted by the Ixodes tick. 3

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Section: Late Lyme Disease and Arthritismentioning

confidence: 99%

Section: Late Lyme Disease and Arthritismentioning

confidence: 99%

Lyme Disease and the Orthopaedic Implications of Lyme Arthritis

Smith

Cruz

Milewski

et al. 2011

American Academy of Orthopaedic Surgeon

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“…Overall, the prognosis of children with Lyme arthritis appears to be good, with most series reporting that 10%-20% of patients recover each year even without specific therapy 3 . Most do not develop chronic or disabling arthritis, regardless of treatment status 3,7,8 , although at least one group argued that almost 25% of patients continued to have joint symptoms more than 1 year after treatment 9 . Complicating interpretation of these studies is that patients in these case series were treated with a variety of interventions, including prolonged courses of antibiotics, disease-modifying antirheumatic agents (DMARD), and surgical synovectomy.…”

Section: Rheumatologymentioning

confidence: 96%

“…The 3 patients who did achieve remission required 15-56 weeks of additional therapy, longer than the time to remission in the DMARD-treated patients. These 3 cases likely reflect the natural course of the disease, as many cases of persistent arthritis have been shown to gradually resolve without any therapy 3,7,8,32 . These data suggesting that the immunopathogenesis of acute and persistent Lyme arthritis differ are especially important in view of the risks associated with longterm antibiotic use and, in cases of intravenous treatment, line complications and sepsis 12,28,33 .…”

Section: Rheumatologymentioning

confidence: 96%

Outcomes of Children Treated for Lyme Arthritis: Results of a Large Pediatric Cohort

Tory

Zurakowski²,

Sundel³

2010

J Rheumatol

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“…30% steigen die IgM-Antikörper unter antibiotischer Therapie an und bestätigen die klinische Diagnose. Untersuchungen von Kindern mit Erythema migrans, Lyme-Arthritis und Neuroborreliose zeigten nach rechtzeitiger, ausreichend dosierter Antibiotikabehandlung eine sehr gute Heilung [9,12,26,28,29,30,31]]. Eine durchgemachte Borrelieninfektion hinterlässt keine bleibende Immunität.…”

Section: Diagnostikunclassified

Kinderdermatologie

Hofmann¹,

Schnopp²

2009

Hautarzt

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We review important aspects of bacterial skin diseases in children, most commonly caused by Staphylococcus aureus, group A beta-hemolytic streptococci (Streptococcus pyogenes) and Borrelia burgdorferi. For early diagnosis of Lyme borreliosis in children it is important to be familiar with the variable clinical presentation of erythema migrans and early hematogenic dissemination with multiple erythemata migrantia. Treatment of impetigo in children requires consideration of concomitant diseases, the specific pathogen as well as local resistance patterns. Recently retapamulin has been released as a new antibiotic for topical use in impetigo contagiosa. Perianal streptococcal disease has been underdiagnosed and is an important differential diagnosis of perianal skin disease in children. Diagnosis is made by culturing group A beta-hemolytic streptococci; a 2-week course of oral penicillin represents the treatment of choice.

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Pediatric Lyme Arthritis: Clinical Spectrum and Outcome

Cited by 35 publications

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Lyme Disease and the Orthopaedic Implications of Lyme Arthritis

Lyme Disease and the Orthopaedic Implications of Lyme Arthritis

Outcomes of Children Treated for Lyme Arthritis: Results of a Large Pediatric Cohort

Kinderdermatologie

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