Treatment of Lyme arthritis.
OBJECTIVE
To test treatment regimens for Lyme arthritis.


METHODS
Patients were randomly assigned to treatment with doxycycline or amoxicillin plus probenecid for 30 days. Patients who had persistent arthritis for at least 3 months after treatment with oral antibiotics or parenteral penicillin were given intravenous ceftriaxone for 2 weeks.


RESULTS
Eighteen of the 20 patients treated with doxycycline and 16 of the 18 patients who completed the amoxicillin regimen had resolution of the arthritis within 1-3 months after study entry. However, neuroborreliosis later developed in 5 patients, 4 of whom had received the amoxicillin regimen. Of 16 patients (2 from the oral antibiotic study and 14 additional patients) who had persistent arthritis despite previous oral antibiotics or parenteral penicillin, none had resolution of the arthritis within 3 months after ceftriaxone therapy. The HLA-DR4 specificity and OspA reactivity were associated with a lack of response.


CONCLUSIONS
Lyme arthritis can usually be treated successfully with oral antibiotics, but patients may still develop neuroborreliosis. Patients with certain genetic and immune markers may have persistent arthritis despite treatment with oral or intravenous antibiotics.
Steere
A C
AC
New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts.
Levin
R E
RE
Molloy
P J
PJ
Kalish
R A
RA
Abraham
J H
JH
Liu
N Y
NY
Schmid
C H
CH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage* / Q000009:adverse effects; D002443:Ceftriaxone / Q000008:administration & dosage* / Q000009:adverse effects; D004318:Doxycycline / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D007275:Injections, Intravenous; D008193:Lyme Disease / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011339:Probenecid / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
D006684:HLA-DR Antigens; D002443:Ceftriaxone; D000658:Amoxicillin; D004318:Doxycycline; D011339:Probenecid