Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 May 8;15(1):35.
doi: 10.1186/s12969-017-0166-0.

When a patient suspected with juvenile idiopathic arthritis turns out to be diagnosed with an infectious disease - a review of Lyme arthritis in children

Krzysztof Orczyk  1 , Joanna Świdrowska-Jaros  1 , Elżbieta Smolewska  2
Affiliations
Review

When a patient suspected with juvenile idiopathic arthritis turns out to be diagnosed with an infectious disease - a review of Lyme arthritis in children

Krzysztof Orczyk et al. Pediatr Rheumatol Online J. .

Abstract

The Lyme arthritis is a common manifestation of infection with Borrelia burgdorferi spirochete. Despite its infectious background, the inflammation clinically and histopatologically resembles juvenile idiopathic arthritis. As it affects a considerable number of Lyme disease patients, it should be routinely considered in differential diagnosis. Development of arthritis is partially dependent on spirochetal factors, including the ribosomal spacer type and the sequence of outer surface protein C. Immunological background involves Th1-related response, but IL-17 provides an additional route of developing arthritis. Autoimmune mechanisms may lead to antibiotic-refractory arthritis. The current diagnostic standard is based on a 2-step testing: ELISA screening and immunoblot confirmation. Other suggested methods contain modified two-tier test with C6 ELISA instead of immunoblot. An initial 28-day course of oral antibiotics (doxycycline, cefuroxime axetil or amoxicillin) is a recommended treatment. Severe cases require further anti-inflammatory management. Precise investigation of new diagnostic and therapeutic approaches is advisable.

Keywords: Lyme arthritis; Lyme disease; Pathogenesis; Symptoms; Treatment.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Erythema migrans in a 9-year-old boy after tick bite
Fig. 2
Fig. 2
Bilateral knee arthritis in a serological-positive (Borrelia burgdorferi) 6-year-old girl
Fig. 3
Fig. 3
Set of changes in cytokine profile and concentrations of cells in the pathogenesis of LA; abbreviations explained in the text
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Steere AC, Broderick TF, Malawista SE. Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. Am J Epidemiol. 1978;108:312–21. doi: 10.1093/oxfordjournals.aje.a112625. - DOI - PubMed
    1. Torbahn G, Hofmann H, Allert R, et al. Efficacy and safety of pharmacological agents in the treatment of erythema migrans in early Lyme borreliosis-systematic review protocol. Syst Rev. 2016;5:73. doi: 10.1186/s13643-016-0251-3. - DOI - PMC - PubMed
    1. Arvikar SL, Steere AC. Diagnosis and treatment of Lyme arthritis. Infect Dis Clin North Am. 2015;29:269–80. doi: 10.1016/j.idc.2015.02.004. - DOI - PMC - PubMed
    1. Steere AC, Malawista SE, Snydman DR, et al. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three connecticut communities. Arthritis Rheum. 1977;20:7–17. doi: 10.1002/art.1780200102. - DOI - PubMed
    1. Steere AC, Bartenhagen NH, Craft JE, et al. The early clinical manifestations of Lyme disease. Ann Intern Med. 1983;99:76–82. doi: 10.7326/0003-4819-99-1-76. - DOI - PubMed