title: Clinical characteristics, treatment and outcome of children with Lyme arthritis in Nova Scotia.
abstract: BACKGROUND
  Lyme disease is an emerging problem in Nova Scotia. Lyme arthritis is a late manifestation of Lyme disease.
  
  
  OBJECTIVE
  To describe the demographic characteristics, referral patterns and clinical course of children diagnosed with Lyme arthritis in a tertiary care pediatric rheumatology clinic in Nova Scotia.
  
  
  METHODS
  In the present retrospective chart review, subjects diagnosed with Lyme arthritis between 2006 and 2013 were identified through the clinic database. Demographic variables, referral patterns, clinical presentation and information regarding treatment course and outcome were collected.
  
  
  RESULTS
  Seventeen patients were identified; 76% presented in 2012 and 2013. In 37.5% of cases, the referring physician suspected Lyme disease. Most patients presented with one or more painful and/or swollen joints; 94% had knee involvement. Only three of 17 patients had a history of erythema migrans and four of 17 recalled a tick bite. Five patients had a history of neurological manifestations consistent with Lyme disease, although, none had a diagnosis made at the time. Arthritis usually resolved after treatment with standard antibiotics; however, at last follow-up, two patients had antibiotic refractory Lyme arthritis, with one having joint damage despite aggressive arthritis treatment.
  
  
  CONCLUSIONS
  A significant increase in cases of Lyme arthritis has recently been recognized in a pediatric rheumatology clinic in Nova Scotia. A history of a tick bite or erythema migrans were not sensitive markers of Lyme arthritis, and this diagnosis was often not considered by the referring physician. Educational initiatives should be undertaken to increase local awareness of this treatable cause of arthritis in children.
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Pier Diane
authors.initials: PD
authors.lastname: Glaude
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Huber
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Timothy
authors.initials: T
authors.lastname: Mailman
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Ramsey
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Bianca
authors.initials: B
authors.lastname: Lang
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stringer
keywords: Antibiotic refractory; Lyme arthritis; Lyme disease; Pediatrics