Universität zu Köln

Nimmrich, S., Becker, I. and Horneff, G. (2014). Intraarticular corticosteroids in refractory childhood Lyme arthritis. Rheumatol. Int., 34 (7). S. 987 - 995. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1437-160X

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Abstract

Lyme arthritis caused by infection with Borrelia burgdorferi is a common late manifestation of Lyme borreliosis. Current treatment recommendations include at least one oral or intravenous antibiotic course, followed by antirheumatic therapy in case of refractory arthritis. We reviewed the course of 31 children with Lyme arthritis who had received antibiotic treatment and assessed outcome and requirement of antirheumatic therapy. Of a total of 31 patients, 23 (74 %) showed complete resolution of arthritis after one or two courses of antibiotics, whereas in 8 patients (28 %), steroid injections had been performed due to relapsing or remaining symptoms. All of these 8 patients showed immediate resolution of symptoms after intraarticular steroid injections. Four of them (50 %) remained asymptomatic so far with a follow-up period between five up to 40 months. In two cases, multiple intraarticular corticosteroid injections were required; three patients received additional or consecutive treatment with systemic antirheumatic treatment. Patients with antibiotic refractory arthritis showed a higher rate of positivity of the IgG p58 and OspC immunoblot bands (p = 0.05) at presentation. Antibodies against OspA, an indicator of later stage infection, occurred more frequently in the refractory group without reaching significant level. No clinical marker as indicator for severe or prolonged course of Lyme arthritis was identifiable. A quarter of childhood Lyme arthritis patients were refractory to antibiotics and required antirheumatic treatment. Intraarticular steroid injections in childhood Lyme arthritis refractory to antibiotics can lead to marked clinical improvement.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Nimmrich, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, I. UNSPECIFIED UNSPECIFIED UNSPECIFIED Horneff, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-434742
DOI:	10.1007/s00296-013-2923-9
Journal or Publication Title:	Rheumatol. Int.
Volume:	34
Number:	7
Page Range:	S. 987 - 995
Date:	2014
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1437-160X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language BORRELIA-BURGDORFERI; ANTIBIOTIC-TREATMENT; CONTROLLED-TRIALS; DOUBLE-BLIND; DISEASE; CEFTRIAXONE; RESISTANT; THERAPY; FLUID; ASSOCIATION Multiple languages Rheumatology Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/43474