The Journal of Bone and Joint Surgery, Vol 69, Issue 1 96-99, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Lyme arthritis in children. An orthopaedic perspective
RW Culp, AH Eichenfield, RS Davidson, DS Drummond, MR Christofersen and DP Goldsmith
The cases of forty-three children with clinical and serological evidence of
Lyme arthritis that was diagnosed between August 1983 and July 1985 were
evaluated. The mean length of follow-up was twenty months, with a range of
five to thirty months. All of the children lived in or had visited an area
where the disease was known to be endemic. Arthritis was the presenting
feature in more than half of the children, and half of the children had
initially consulted an orthopaedic surgeon, none of whom made the correct
diagnosis. Only twenty patients had a history of erythema chronicum
migrans, the characteristic rash that precedes the arthritis, and for only
nineteen children was there any recollection of having been bitten by a
tick. Three patients had Bell palsy and one had a popliteal cyst in
conjunction with the arthritis. All of the patients had oligoarticular
involvement. The knee was involved in all but two patients. Recurrent
attacks of synovitis were common. Effusion was the only radiographic
abnormality that was observed, and it was found in thirty-two patients. The
sedimentation rate was elevated in thirty of thirty-six patients.
Immunofluorescent serology for Lyme disease, which is sensitive and
specific, was uniformly positive. Of thirty-three patients who were treated
with oral administration of penicillin or tetracycline alone, thirty-one
responded, while two patients who had recurrent attacks of the disease
responded to parenteral administration of antibiotics. The remaining ten
patients responded to combinations of orally and parenterally administered
antibiotics. Longer follow-up is needed to further document the apparently
low rate of relapse after antibiotic therapy in this young population.
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