Skip to main content

Advertisement

SpringerLink
Log in

Intraarticular corticosteroids in refractory childhood Lyme arthritis

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

Lyme arthritis caused by infection with Borrelia burgdorferi is a common late manifestation of Lyme borreliosis. Current treatment recommendations include at least one oral or intravenous antibiotic course, followed by antirheumatic therapy in case of refractory arthritis. We reviewed the course of 31 children with Lyme arthritis who had received antibiotic treatment and assessed outcome and requirement of antirheumatic therapy. Of a total of 31 patients, 23 (74 %) showed complete resolution of arthritis after one or two courses of antibiotics, whereas in 8 patients (28 %), steroid injections had been performed due to relapsing or remaining symptoms. All of these 8 patients showed immediate resolution of symptoms after intraarticular steroid injections. Four of them (50 %) remained asymptomatic so far with a follow-up period between five up to 40 months. In two cases, multiple intraarticular corticosteroid injections were required; three patients received additional or consecutive treatment with systemic antirheumatic treatment. Patients with antibiotic refractory arthritis showed a higher rate of positivity of the IgG p58 and OspC immunoblot bands (p = 0.05) at presentation. Antibodies against OspA, an indicator of later stage infection, occurred more frequently in the refractory group without reaching significant level. No clinical marker as indicator for severe or prolonged course of Lyme arthritis was identifiable. A quarter of childhood Lyme arthritis patients were refractory to antibiotics and required antirheumatic treatment. Intraarticular steroid injections in childhood Lyme arthritis refractory to antibiotics can lead to marked clinical improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Nau R, Christen HJ et al (2009) Lyme disease–current state of knowledge. Dtsch Arztebl Int 106(5):72–81 quiz 82, I

    PubMed Central  PubMed  Google Scholar 

  2. Baranton G, Postic D et al (1992) Delineation of Borrelia burgdorferi sensu stricto, Borrelia garinii sp. nov., and group VS461 associated with Lyme borreliosis. Int J Syst Bacteriol 42(3):378–383

    Article  CAS  PubMed  Google Scholar 

  3. Steere AC, Levin RE et al (1994) Treatment of Lyme arthritis. Arthritis Rheum 37(6):878–888

    Article  CAS  PubMed  Google Scholar 

  4. Bentas W, Karch H et al (2000) Lyme arthritis in children and adolescents: outcome 12 months after initiation of antibiotic therapy. J Rheumatol 27(8):2025–2030

    CAS  PubMed  Google Scholar 

  5. Huppertz HI, Böhme M, Standaert SM, Karch H, Plotkin SA (1999) Incidence of Lyme borreliosis in the Würzburg region of Germany. Eur J Clin Microbiol Infect Dis 18(10):697–703

    Article  CAS  PubMed  Google Scholar 

  6. Tory HO, Zurakowski D, Sundel RP (2010) Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort. J Rheumatol 37(5):1049–1055

    Article  PubMed  Google Scholar 

  7. Huppertz HI, Bentas W, Haubitz I, Girschick HJ, Ganser G, Thon A, Suschke HJ, Schauer-Petrowskaja C, Minden K, Schuchmann L (1998) Diagnosis of paediatric Lyme arthritis using a clinical score. Eur J Pediatr 157(4):304–308

    Article  CAS  PubMed  Google Scholar 

  8. Brescia AC, Rose CD et al (2009) Prolonged synovitis in pediatric Lyme arthritis cannot be predicted by clinical or laboratory parameters. Clin Rheumatol 28(5):591–593

    Article  PubMed  Google Scholar 

  9. Klempner MS, Hu LT et al (2001) Two controlled trials of antibiotic treatment in patients with persistent symptoms and a history of Lyme disease. N Engl J Med 345(2):85–92

    CAS  PubMed  Google Scholar 

  10. Oksi J, Nikoskelainen J et al (2007) Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study. Eur J Clin Microbiol Infect Dis 26(8):571–581

    Article  CAS  PubMed  Google Scholar 

  11. Dattwyler RJ, Halperin JJ et al (1988) Treatment of late Lyme borreliosis: randomised comparison of ceftriaxone and penicillin. Lancet 1(1988):1191–1194

    Article  CAS  PubMed  Google Scholar 

  12. Gasser R, Reisinger E, Eber B, Pokan R, Seinkost G, Berglöff J, Horwarth R, Se-Daj B (1995) Cases of Lyme borreliosis resistant to conventional treatment: improved symptoms with cephalosporin plus specific betalactamase inhibition. Microb Drug Resist 1:341–344

    Article  CAS  PubMed  Google Scholar 

  13. Preac-Mursic V, Weber K, Pfister HW, Wilske B, Gross B, Baumann A, Prokop J (1989) Survival of Borrelia burgdorferi in antibiotically treated patients with Lyme borreliosis. Infection 17:355–359

    Article  CAS  PubMed  Google Scholar 

  14. Krupp LB, Hyman LG et al (2003) Study and treatment of post Lyme disease (STOP-LD): a randomized double masked clinical trial. Neurology 60(12):1923–1930

    Article  CAS  PubMed  Google Scholar 

  15. Wormser GP, Dattwyler RJ et al (2006) The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 43(9):1089–1134

    Article  PubMed  Google Scholar 

  16. DGPI Handbuch: Infektionen bei Kindern und Jugendlichen, 4. erweiterte und neu bearbeitete Auflage mit 984 Seiten, Hardcover, Futuramed Verlag, München ISBN 3-923599-90-0

  17. Fallon BA, Keilp JG et al (2008) A randomized, placebo-controlled trial of repeated IV antibiotic therapy for Lyme encephalopathy. Neurology 70(13):992–1003

    Article  CAS  PubMed  Google Scholar 

  18. O’Connell S (2010) Lyme borreliosis: current issues in diagnosis and management. Curr Opin Infect Dis 23(3):231–235

    Google Scholar 

  19. Puéchal X (2007) Non antibiotic treatments of Lyme borreliosis. Med Mal Infect 37(7–8):473–478

    Article  PubMed  Google Scholar 

  20. Cimmino M, Moggiana G et al (1996) Treatment of Lyme arthritis, Dipartimento di Medicina Interna, Università di Genova, Italy. Infection 24(1):91–93

    Article  CAS  PubMed  Google Scholar 

  21. Steere AC, Angelis SM (2006) Therapy for Lyme arthritis: strategies for the treatment of antibiotic-refractory arthritis. Arthritis Rheum 54(10):3079–3086

    Article  CAS  PubMed  Google Scholar 

  22. Ogrinc K, Logar M et al (2006) Doxycycline versus ceftriaxone for the treatment of patients with chronic Lyme borreliosis. Wien Klin Wochenschr 118(21–22):696–701

    Article  CAS  PubMed  Google Scholar 

  23. Zulian F, Martini G et al (2004) Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology (Oxford) 43(10):1288–1291

    Article  CAS  PubMed  Google Scholar 

  24. Steere AC, Duray PH et al (1988) Spirochetal antigens and lymphoid cell surface markers in Lyme synovitis. Comparison with rheumatoid synovium and tonsillar lymphoid tissue. Arthritis Rheum 31(4):487–495

    Article  CAS  PubMed  Google Scholar 

  25. Cameron D, Gaito A et al (2004) Evidence-based guidelines for the management of Lyme disease. Expert Rev Anti Infect Ther 2(1 Suppl):S1–S13

    PubMed  Google Scholar 

  26. Pavia C, Inchiosa MA Jr et al (2002) Efficacy of short-course ceftriaxone therapy for Borrelia burgdorferi infection in C3H mice. Antimicrob Agents Chemother 46(1):132–134

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Akin E, McHugh G et al (1999) The immunoglobulin (IgG) antibody response to OspA and OspB correlates with severe and prolonged Lyme arthritis and the IgG response to P35 correlates with mild and brief arthritis”. Infect Immun 67(1):173–181

    CAS  PubMed Central  PubMed  Google Scholar 

  28. Kalish R, Leong J et al (1993) Association of treatment-resistant chronic Lyme arthritis with HLA-DR4 and antibody reactivity to OspA and OspB of Borrelia burgdorferi”. Infect Immun 61(7):2774–2779

    CAS  PubMed Central  PubMed  Google Scholar 

  29. Panelius J, Seppala I et al (1999) Evaluation of treatment responses in late Lyme borreliosis on the basis of antibody decrease during the follow-up period. Eur J Clin Microbiol Infect Dis 18(9):621–629

    Article  CAS  PubMed  Google Scholar 

  30. Chandra A, Wormser GP et al (2011) Anti-Borrelia burgdorferi antibody profile in post-Lyme disease syndrome. Clin Vaccine Immunol 18(5): 767–771

    Google Scholar 

  31. Eberhard BA, Laxer RM et al (1994) Local synthesis of both macrophage and T cell cytokines by synovial fluid cells from children with juvenile rheumatoid arthritis. Clin Exp Immunol 96(2):260–266

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Snydman DR, Schenkein DP, Berardi VP, Lastavica CC, Pariser KM (1986) Borrelia burgdorferi in joint fluid in chronic Lyme arthritis. Ann Intern Med 104(6):798–800

    Article  CAS  PubMed  Google Scholar 

  33. Nocton J, Dressler F et al (1994) Detection of Borrelia burgdorferi DNA by polymerase chain reaction in synovial fluid from patients with Lyme arthritis. J Engl J Med 330(4):229–234

    Article  CAS  Google Scholar 

  34. Hulinska D, Votypka J et al (1999) Persistence of Borrelia garinii and Borrelia afzelii in patients with Lyme arthritis. Zentralbl Bakteriol 289(3):301–318

    Article  CAS  PubMed  Google Scholar 

  35. Steere AC, Schoen RT et al (1987) The clinical evolution of Lyme arthritis. Ann Intern Med 107(5):725–731

    Article  CAS  PubMed  Google Scholar 

  36. Malawista SE (2000) Opinion:: Resolution of lyme arthritis, acute or prolonged: a new look. Inflammation 24(6):493–504

    Google Scholar 

  37. Feder HM Jr, Johnson BJ et al (2007) A critical appraisal of “chronic Lyme disease”. N Engl J Med 357(14):1422–1430

    Article  CAS  PubMed  Google Scholar 

  38. Lunemann JD, Gelderblom H et al (2007) Cerebrospinal fluid-infiltrating CD4+ T cells recognize Borrelia burgdorferi lysine-enriched protein domains and central nervous system autoantigens in early Lyme encephalitis. Infect Immun 75(1):243–251

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Steere AC, Dwyer E et al (1990) Association of chronic Lyme arthritis with HLA-DR4 and HLA-DR2 alleles. N Engl J Med 323(4):219–223

    Article  CAS  PubMed  Google Scholar 

  40. Klempner MS (2002) Controlled trials of antibiotic treatment in patients with post-treatment chronic Lyme disease. Vector Borne Zoonotic Dis 2(4):255–263

    Article  PubMed  Google Scholar 

  41. Carlson D, Hernandez J et al (1999) Lack of Borrelia burgdorferi DNA in synovial samples from patients with antibiotic treatment-resistant Lyme arthritis. Arthritis Rheum 42(12):2705–2709

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Centre of Paediatric Rheumatology, Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany

    S. Nimmrich & G. Horneff

  2. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

    I. Becker

Authors
  1. S. Nimmrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. I. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. Horneff
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Nimmrich.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nimmrich, S., Becker, I. & Horneff, G. Intraarticular corticosteroids in refractory childhood Lyme arthritis. Rheumatol Int 34, 987–994 (2014). https://doi.org/10.1007/s00296-013-2923-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-013-2923-9

Keywords

Search

Navigation