Updated Clinical Practice Guidelines for Lyme Disease, Lyme Arthritis

Pediatric Considerations

Dr. Zemel

Addressing the particular needs of children suspected of having Lyme arthritis was Lawrence Zemel, MD, a pediatric rheuma­tologist at Connecticut Children’s Medical Center, Hartford, who led the panel’s pediatric subcommittee on arthritis management. 

“When a child shows up in an [emergency department] or an office with one swollen joint,” says Dr. Zemel, “we have to parse out whether it is Lyme arthritis, septic arthritis or another form of acute arthritis. Septic arthritis is a medical emergency, so it is important to at least consider the possibility that this is what you’re dealing with. 

“However, many practitioners rush to the diagnosis of septic arthritis and call an orthopedic surgeon. And, if the orthopedic surgeon has tunnel vision, then he or she [may] decide to intervene operatively, essentially overtreating
the condition. 

“This happens fairly frequently [because] providers are not considering Lyme disease.”

Providing information on the main distinctions between septic arthritis and Lyme arthritis, Dr. Zemel notes, “Septic arthritis almost always involves a single joint, whereas Lyme arthritis may involve two to three different joints, sometimes sequentially. In addition, septic arthritis is almost always associated with fever. If you suspect septic arthritis, then aspirate the joint and examine the fluid. If the cell count is less than 70,000/uL, then septic arthritis is unlikely.”

Adding a dose of caution about anti­biotics, he says, “A small segment of physicians tend to prescribe long-term antibiotics. With Lyme arthritis, however, neither children nor adults should be given more than two months of antibiotics.”

“In pediatric patients, if joint swelling remains after two months of antibiotics, intra-articular steroids can be helpful. Also note, when working up a child for Lyme arthritis, it is unnecessary to check for other co-infection tests unless the child has had a prolonged fever and/or other blood abnormalities.”

Elizabeth Hofheinz, MPH, MEd, is a freelance medical editor and writer based in the greater New Orleans area.

References

1. Lantos PM, Rumbaugh J, Bockenstedt, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Care Res (Hoboken). 2021 Jan;73(1):1–9.
2. Lantos PM, Rumbaugh J, Bockenstedt, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol. 2020 Nov 29.