Best Practice Case Studies-Diagnosis and Treatment of Lyme Disease

Pdf Summary

Lyme arthritis is a late-stage manifestation of infection by the tick-borne spirochete Borrelia burgdorferi, most commonly occurring in the United States. It usually presents months after the initial tick bite, often as the primary symptom without prior signs of the disease. Characterized by joint swelling and pain, primarily in larger joints such as the knees, the condition may persist for several years without systemic symptoms. Diagnosis relies primarily on serologic testing, supported by synovial fluid PCR testing for B. burgdorferi DNA, though PCR is not reliable post-antibiotic therapy.<br /><br />Initial treatment typically involves a 30-day course of oral antibiotics like doxycycline or amoxicillin. If this is ineffective, intravenous ceftriaxone might be required. However, a small percentage of patients develop antibiotic-refractory arthritis, necessitating additional treatments such as non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), or surgical intervention like synovectomy. <br /><br />Pathogen strains, genetic predispositions, and immune responses contribute to the disease's variability. For instance, the highly inflammatory RST1 strains of B. burgdorferi are linked with more aggressive forms of arthritis. Untreated, Lyme arthritis can cause ongoing joint damage but progresses slowly enough to be managed effectively in most patients. <br /><br />Epidemiologically, Lyme arthritis has been a focus since its initial recognition in the 1970s in Connecticut, with recent CDC estimates indicating significantly higher incidences than previously reported. Although residing primarily in the northeastern U.S., various other states also report cases due to the distribution of carrier ticks. Overall, while treatment success rates are high, monitoring and managing antibiotic-refractory cases remain complex due to factors like excessive immune responses or infection-induced autoimmunity.

Meta Tag

Edition 2nd Edition

Related Case 2nd Edition, CASE 30

Topic Knee

Keywords

2nd Edition, CASE 30

2nd Edition

Knee

Lyme arthritis

Borrelia burgdorferi

tick-borne infection

joint swelling

serologic testing

antibiotic-refractory

RST1 strains

immune response

Connecticut

CDC estimates