Spirochete Borrelia burgdorferi causes arthritis in up to 70 percent of persons who are not treated. The spirochete is inoculated by the Ixodes tick.
The patient experiences intermittent arthralgias and myalgias, but not arthritis, occur within days or weeks of inoculation of the spirochete. Later, there are three patterns of joint disease:
- Fifty percent of untreated persons experience intermittent episodes of monarthritis or oligoarthritis involving the knee and/or other large joints. The symptoms wax and wane without treatment over months, and each year 10 to 20 percent of patients report loss of joint symptoms.
- Twenty percent of untreated persons develop a pattern of waxing and waning arthralgias.
- Ten percent of patients develop chronic inflammatory synovitis resulting in erosive lesions and destruction of the joint.
Treatment
Lyme arthritis generally responds well to oral therapy.
A regimen of oral doxycycline, oral amoxicillin plus probenecid, or parenteral ceftriaxone for a period of 3 to 4 weeks is recommended. Patients who do not respond to such a regimen are unlikely to benefit from additional therapy.
Failure of therapy is associated with host features rather than spirochetal properties . New techniques using PCR amplification or spirochetal DNA may be useful in the monitoring of patients in whom conventional therapy fails.
Patients who have negative -results of synovial fluid PCR and who fail to respond to initial therapy are highly unlikely to benefit from additional antimicrobial therapy.
Lyme arthritis which is antibiotic resistant may be treated with hydroxychloroquine or methotrexate. Gabapentin and minocycline have shown some good results in pilot studies but detailed clinical trials are needed.
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