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.