Treatment of lyme arthritis

Objective. To test treatment regimens for Lyme arthritis. Methods. Patients were randomly assigned to treatment with doxycycline or amoxicillin plus probenecid for 30 days. Patients who had persistent arthritis for at least 3 months after treatment with oral antibiotics or parenteral penicillin were...

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Bibliographic Details
Published in:Arthritis and rheumatism 1994-06, Vol.37 (6), p.878-888
Main Authors: Steere, Allen C., Levin, Robert E., Molloy, Philip J., Kalish, Robert A., Abraham Iii, James H., Liu, Nancy Y., Schmid, Christopher H.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Amoxicillin - administration & dosage
Amoxicillin - adverse effects
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Biological and medical sciences
Ceftriaxone - administration & dosage
Ceftriaxone - adverse effects
Doxycycline - administration & dosage
Drug Therapy, Combination
Female
Follow-Up Studies
HLA-DR Antigens - blood
Humans
Injections, Intravenous
Lyme Disease - blood
Lyme Disease - drug therapy
Lyme Disease - immunology
Male
Medical sciences
Middle Aged
Pharmacology. Drug treatments
Probenecid - administration & dosage
Probenecid - adverse effects
Treatment Outcome
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Summary:Objective. To test treatment regimens for Lyme arthritis. Methods. Patients were randomly assigned to treatment with doxycycline or amoxicillin plus probenecid for 30 days. Patients who had persistent arthritis for at least 3 months after treatment with oral antibiotics or parenteral penicillin were given intravenous ceftriaxone for 2 weeks. Results. Eighteen of the 20 patients treated with doxycycline and 16 of the 18 patients who completed the amoxicillin regimen had resolution of the arthritis within 1–3 months after study entry. However, neuroborreliosis later developed in 5 patients, 4 of whom had received the amoxicillin regimen. Of 16 patients (2 from the oral antibiotic study and 14 additional patients) who had persistent arthritis despite previous oral antibiotics or parenteral penicillin, none had resolution of the arthritis within 3 months after ceftriaxone therapy. The HLA‐DR4 specificity and OspA reactivity were associated with a lack of response. Conclusion. Lyme arthritis can usually be treated successfully with oral antibiotics, but patients may still develop neuroborreliosis. Patients with certain genetic and immune markers may have persistent arthritis despite treatment with oral or intravenous antibiotics.
ISSN:0004-3591
1529-0131
DOI:10.1002/art.1780370616