Diagnosis and Treatment of Lyme Arthritis

Abstract

SYNOPSIS In the United States, Lyme arthritis is the most common feature of late stage infection with the tick-borne spirochete, Borrelia burgdorferi, usually beginning months after the initial tick bite. However, in some patients, including most of those seen today, the earlier phases of the infection are asymptomatic and arthritis is the presenting manifestation of the disease. Patients with Lyme arthritis have intermittent or persistent attacks of joint swelling and pain in one or a few large joints, especially the knee, usually over a period of several years, without prominent systemic manifestations. Serologic testing is the mainstay of diagnosis. Synovial fluid PCR testing for B. burgdorferi DNA is often positive prior to treatment, but it is not a reliable marker of spirochetal eradication after antibiotic therapy. Responses to oral or intravenous antibiotic treatment are generally excellent, although a small percentage of patients have persistent synovitis after 2-3 months of oral and IV antibiotics, which usually then responds to anti-inflammatory therapies, disease modifying anti-rheumatic drugs (DMARDs), or synovectomy. This chapter reviews the clinical manifestations, diagnosis, and management of Lyme arthritis.

Matrix metalloproteinase-10 is a target of T and B cell responses that correlate with synovial pathology in patients with antibiotic-refractory Lyme arthritis

“…In these patients, the synovial lesion, which shows marked synovial hypertrophy, vascular proliferation, infiltrating mononuclear cells, and intense expression of HLA-DR molecules, is similar to that seen in other forms of chronic inflammatory arthritis, including rheumatoid arthritis (RA) [7]. After antibiotic therapy, we treat antibiotic-refractory LA patients with disease modifying anti-rheumatic drugs (DMARDs), the treatment used for other forms of chronic inflammatory arthritis [6,8]. …”

Antibody Response to Lyme Disease Spirochetes in the Context of VlsE-Mediated Immune Evasion

“…Borrelia burgdorferi, the principal human pathogen in the United States, is responsible for approximately 300,000 LD cases per year (1). LD is problematic because early diagnosis is easily missed due to flu-like symptoms, which only transiently appear in humans during an early stage of disease (2)(3)(4)(5). When missed and therefore left untreated, LD becomes chronic, presenting itself as skin lesions, arthritis, and carditis and occasionally with subsequent nervous system involvement (6,7).…”

Development of Oral Vaccines Against Lyme Disease

“…In the United States, arthritis is the most common manifestation of the late stage, and it affects one-third of the Lyme Disease patients [32]. Lyme arthritis occurs months to years after the initial tick bite and it causes intermittent or persistent attacks of swelling and pain in the large joints, especially the knee [10,32].…”

“…Lyme arthritis occurs months to years after the initial tick bite and it causes intermittent or persistent attacks of swelling and pain in the large joints, especially the knee [10,32]. Development of Lyme arthritis is associated with infection with B. burgdorferi OspC type A strain, which causes disseminated infection in humans [33], and is responsible for approximately 40% of the infections in the northeastern U.S. [32]. Although uncommon in children, encephalitis, encephalopathy, and polyneuropathy are also associated with late Lyme Disease [8].…”

“…Furthermore, joint inflammation may persist in a minority of patients for months or several years, despite receiving repeated courses of antibiotic therapy for late Lyme arthritis. This is termed Antibiotic-Refractory Lyme Arthritis [32].…”