Lyme Arthritis: Presentation, Diagnosis & Treatment

Case Outcome

We treated the patient in the opening scenario with a one-month course of 2 g of ceftriaxone via IV daily. During the treatment, he noted improvement in his knee swelling and had only mild residual swelling at completion. An NSAID was started.

Several weeks later, the patient’s right knee swelling recurred, and some milder swelling in his right ankle developed. He had partial improvement with a steroid injection in the knee. Methotrexate was started at a dose of 15 mg/week, along with folic acid.

He markedly improved with metho­trexate treatment by the six-week visit, and inflammatory tests that had been persistently elevated normalized.

After three months, his methotrexate dose was lowered, and it was stopped completely after five months without any recurrence of his arthritis.

John N. Aucott, MD, is the director of the Johns Hopkins Rheumatology Lyme Disease Research Center, and an associate professor of medicine in the Division of Rheumatology and Department of Medicine at Johns Hopkins University School of Medicine, Baltimore. He is also the immediate past chair of the HHS Tick-Borne Disease Working Group of the Office of HIV/AIDS and Infectious Disease Policy, Office of the Assistant Secretary of Health, Department of Health and Human Services (https://www.hhs.gov/ash/advisory-committees/tickbornedisease).

Sheila L. Arvikar, MD, is a rheumatologist in the Division of Rheumatology, Allergy, and Immunology and the Center for Immunology and Inflammatory Diseases at Massachusetts General Hospital (MGH), Boston. She staffs the MGH Lyme arthritis clinic with Allen Steere, MD. She receives support from the Global Lyme Alliance for her clinical research studies in Lyme arthritis.

References

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