Effective treatment of Lyme disease-related arthritis may depend on proper diagnosis

Early and proper diagnosis is the best way to prevent the development of Lyme disease-related arthritis in patients, according to recently published research.

The investigators for the study, which appears in the February issue of the Journal of the American Academy of Orthopaedic Surgeons, also found that patients who do develop the condition can be treated successfully with antibiotics.

“When diagnosed early, most patients do not develop Lyme arthritis,” paper author Aristides Cruz, MD, stated in a press release. “But when correct diagnosis is delayed, arthritis can occur and requires intervention before permanent joint damage develops.”

Defining Lyme arthritis

Lyme arthritis can be defined as a painful, swollen joint causing stiffness similar to osteoarthritis, and it occurs commonly in the late stages of Lyme disease. This is usually several months after the onset of the disease. According to Cruz, about 60% of patients left untreated for Lyme disease in its early stages will develop Lyme arthritis.

“Diagnosing Lyme arthritis can be problematic, especially in patients who do not report a rash and who have fever, since it can be confused with a bacterial joint infection, particularly in children,” Cruz stated. He added that most cases of Lyme arthritis are brief and involve a single joint – typically the knee. “In general, the diagnosis is multifaceted and involves a thorough understanding of the common clinical and epidemiologic features of the disease.”

Following an initial period of joint pain and swelling, patients with Lyme arthritis could experience recurring symptoms until the disease is diagnosed.

Treating a case

Though rash occurs in most patients with Lyme disease, many of those who develop Lyme arthritis either never develop the rash or notice it when it occurs. This can make diagnosis more difficult.

Once diagnosis occurs, however, the authors reported that Lyme arthritis has “an excellent prognosis with appropriate treatment,” adding that most patients respond well to a single course of antibiotics. The key, they noted, is to diagnose the disease early and differentiate between Lyme arthritis and other types of arthritis.

“In most patients, Lyme arthritis can be successfully treated with oral antibiotics,” Cruz stated. “Nonsteroidal anti-inflammatory drugs may also be given to help manage symptoms while the patient is improving.”

Patients who continue to experience symptoms even after antibiotic treatment could require surgery to remove diseased synovial tissue.

References:
Smith BG, et al. Lyme disease and the orthopaedic implications of Lyme arthritis. J Am Acad Orthop Surg. 2011 Feb;19(2):91-100.
www.aaos.org
Disclosures: Smith or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of and has received research or institutional support from Stryker.

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