Non-
antibiotic treatment of
Lyme borreliosis is only indicated in a few specific clinical situations. In chronic
Lyme arthritis, intra-articular
steroids are useful to immediately relieve symptomatic joint effusion. Nevertheless, 4 studies with weak methodological evidence were convergent enough to recommend not proposing
intra-articular injection before or even immediately after
antibiotic treatment. The injection can only be recommended in the treatment of patients whose joint effusion persists despite 2 courses of oral antibiotherapy or one course of IV antibiotherapy. For some experts, the injection can only be made after negative PCR assessment of the joint fluid for spirochetes. This recommendation, although logical, has never been evaluated. Radiation
synovectomy may be indicated in persistent
synovitis after antibiotherapy and before surgical
synovectomy. Further studies are mandatory to confirm the role of radiation
synovectomy in the local
therapy. Arthroscopic
synovectomy can reduce the period of joint
inflammation when persistent
synovitis is associated with significant
pain or limited function. Several experts recommend using the procedure only if
synovitis persists after 2 months of antibiotherapy and a negative PCR joint fluid assessment. Non-steroidal anti-inflammatory drugs are often prescribed for their symptomatic effects. Experimental data is consensual on the deleterious consequences of systemic
corticosteroid therapy.
Corticosteroids are not indicated in Lyme's disease. In post Lyme's disease syndrome, patient complaints may lead to a multidisciplinary therapeutic management and the use of neuro-psychiatric drugs.