title: Outcomes of children treated for Lyme arthritis: results of a large pediatric cohort.
abstract: OBJECTIVE
  Children often develop arthritis secondary to Lyme disease; however, optimal treatment of Lyme arthritis in pediatric patients remains ill-defined. We sought to characterize the outcomes of a large cohort of children with Lyme arthritis treated using the approach recommended by the American Academy of Pediatrics and the Infectious Diseases Society of America.
  
  
  METHODS
  Medical records of patients with Lyme arthritis seen by rheumatologists at a tertiary care children's hospital from 1997 to 2007 were reviewed. Patients were classified with antibiotic responsive or refractory arthritis based on absence or presence of persisting joint involvement 3 months after antibiotic initiation. Treatment regimens and outcomes in patients with refractory arthritis were analyzed.
  
  
  RESULTS
  Of 99 children with Lyme arthritis, 76 had arthritis that responded fully to antibiotics, while 23 developed refractory arthritis. Most patients with refractory arthritis were successfully treated with nonsteroidal antiinflammatory drugs (6 patients), intraarticular steroid injections (4), or disease-modifying antirheumatic drugs (DMARD) (2). Five were lost to followup. Six patients with refractory arthritis were initially treated elsewhere and received additional antibiotic therapy, with no apparent benefit. Three subsequently required DMARD, while 3 had gradual resolution of arthritis without further therapy. Antibiotic responsiveness could not be predicted from our clinical or laboratory data.
  
  
  CONCLUSIONS
  Lyme arthritis in children has an excellent prognosis. More than 75% of referred cases resolved with antibiotic therapy. Of patients with antibiotic refractory arthritis, none in whom followup data were available developed chronic arthritis, joint deformities, or recurrence of infection, supporting current treatment guidelines.
authors.affiliation: Department of Pediatrics, Yale-New Haven Children's Hospital, New Haven, CT 06520-8064, USA. heather.tory@yale.edu
authors.forename: Heather O
authors.initials: HO
authors.lastname: Tory
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.forename: Robert P
authors.initials: RP
authors.lastname: Sundel
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D025065:Borrelia burgdorferi; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008193:Lyme Disease / Q000188:drug therapy*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents