Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
A Comparison of the Presentation, Synovial Fluid Analysis, and Treatment Course in Children and Adults with Lyme Arthritis.
Daikh4, Brian E., Emerson3, Fred, Lucas2, F. Lee, Smith1, Robert, McCarthy1, Carol
In the northeastern United States, Lyme arthritis is an increasingly recognized form of monoarticular inflammatory arthritis in both the pediatric and adult population. We have observed that some cases of pediatric Lyme arthritis may be confused with septic arthritis leading to unnecessary hospitalization and surgical drainage. We wondered how frequently this occurs in children and whether there are differences between the pediatric and adult population in the presentation and management of Lyme arthritis.
Charts of pediatric and adult patients evaluated for Lyme arthritis by rheumatologists and pediatric infectious disease specialists in Portland, ME between January 2002 and July 2008 were reviewed. Patients included for analysis had documented synovitis and positive Lyme serology. Data on clinical presentation, synovial fluid and peripheral blood results, treatment, and clinical course were extracted and subjected to statistical analysis.
29 adults and 50 children met inclusion criteria and were studied. Children were more likely than adults to present acutely (p = 0.01). They were less likely to be weight bearing (p = 0.04), had a higher mean synovial fluid WBC count (p = 0.00004), were more likely to be hospitalized (p = 0.02) and were more likely to have a suspected septic arthritis (p = 0.02), although there was no statistical difference between the two groups with respect to surgical intervention. In contrast, adults received more oral antibiotic courses (p = 0.006). They were less likely to have normal function within four weeks of initiating antibiotic treatment (p = 0.0002), were more likely to have intravenous antibiotics in subsequent treatment courses (p = 0.01), and were more likely to be diagnosed with a persistent arthritis (p = 0.0007).
The presentation of Lyme arthritis in children and adults in our study population differed in the acuity of presentation and subsequent management. Children were more frequently hospitalized for suspected septic arthritis whereas adults were more often managed in the outpatient setting. Yet children tended to have more prompt resolution of their synovitis and received less treatment overall. The clinical spectrum of Lyme arthritis is variable, ranging from chronic indolent synovitis to acute monoarticular arthritis mimicking septic arthritis. In the appropriate geographic and clinical setting, Lyme arthritis should be considered in children presenting with acute monoarticular arthritis. Considering the diagnosis early may prevent hospitalization and needless intervention including surgical drainage.
To cite this abstract, please use the following information:
Daikh, Brian E., Emerson, Fred, Lucas, F. Lee, Smith, Robert, McCarthy, Carol; A Comparison of the Presentation, Synovial Fluid Analysis, and Treatment Course in Children and Adults with Lyme Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1638