AI Article Synopsis
- Report on two patients with persistent Lyme arthritis, one with a prior history of juvenile idiopathic arthritis and the other labeled a non-responder after antibiotic treatment.
- Patient 1 experienced a relapse of arthritis linked to a tick bite, leading to the hypothesis that Lyme borreliosis may trigger arthritis reactivation.
- For Patient 2, despite finding spirochete fragments in a biopsy, the patient improved without further antibiotics, suggesting the importance of timely antibiotic treatment to prevent systemic spread of Lyme-related antigens and chronic arthritis.
- Intra-articular steroid use in Lyme arthritis should be guided by MRI findings to avoid exacerbating inflammation due to unresolved antigenic material.
Article Abstract
Unlabelled: We report on two patients with a persistent Lyme arthritis. In addition both had a peculiar disease history. The first patient had oligoarticular juvenile idiopathic arthritis in remission. Five months after an infected tick bite, she developed a relapse of arthritis in the same knee. We considered Lyme borreliosis as the possible trigger for this reactivation. The disease history of the second patient was that of a classical non-responder. After extensive antibiotic treatment osteolytic lesions became visible. MRI images suggested an erosive arthropathy and arthroscopy was used to investigate possible erosive arthritis. Studies on collected material made us consider the following hypothesis. Despite demonstration of a spirochete fragment in a synovial biopsy, the patient recovered without additional antibiotic treatment.
Conclusion: delay of antibiotic treatment after appearance of erythema migrans may cause systemic spread of the antigen and predispose to Lyme arthritis. If intra-articular steroids are considered when spontaneous resolution of Lyme arthritis does not occur, magnetic resonance imaging of the affected joint, prior to administration, may provide additional information. The success of synovectomy may be related to removal of undegraded antigenic material which may prolong the inflammation.
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| http://dx.doi.org/10.1007/s00431-004-1500-3 | DOI Listing |
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