The long-term course of Lyme arthritis in children

Article Abstract:

Lyme disease is an infectious disease caused by a microorganism transmitted by tick bites. The initial symptom is a characteristic skin rash, which is followed in subsequent years by disorders of the heart, central nervous system, and joints (arthritis). Originally identified in 1975 in the area of Lyme, Connecticut, it was not known for several years that this condition was treatable by antibiotics. In the early years after identification of this disease, 58 children diagnosed with Lyme disease were entered into a study to assess the natural history of the disease. The children did not receive antibiotics for at least the first four years after diagnosis, and for some, who underwent spontaneous remission of the disease, antibiotics were never administered. In recent years, it has been reported that long-term neurological effects can result from Lyme disease infestation, long after the initial infection. Forty-six of the original 58 patients were available for follow-up. At the time of infection, 72 percent of these children had skin rash, 15 percent had flu-like symptoms, and 13 percent had joint pain. Attacks of arthritis, particularly involving the knee, were common in the years following infection. The incidence of arthritis declined over time, and by four years after onset, the majority of the children were symptom-free. Six or more years after onset, two children had Lyme disease-related skin disorders and two had neurological symptoms. Thirty-one percent of the children had brief episodes of joint pain; 3 percent had experienced fatigue. Children with recurrent symptoms often had higher levels of antibodies directed against Borrelia burgdorferi, the causative infectious microorganism, than those without symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prognosis, Arthritis

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The overdiagnosis of Lyme disease

Article Abstract:

Many patients suspected of having Lyme disease may be suffering from other disorders. Lyme disease is an inflammatory disorder that is transmitted by a tick bite. Among 788 patients referred to a clinic for suspected Lyme disease over a 4 1/2-year period, 180 (23%) had active Lyme disease, 156 (20%) had previously had Lyme disease and were currently suffering from another disorder and 452 (57%) did not have Lyme disease. Most of the patients who did not have Lyme disease were suffering from chronic fatigue syndrome or fibromyalgia. Other patients who did not have Lyme disease were suffering from different rheumatic or neurological disorders. Forty-five percent of the patients without Lyme disease had had positive results on tests for Lyme disease in other laboratories.

Diagnosis, Quality management

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Leflunomide or methotrexate for juvenile rheumatoid arthritis

Article Abstract:

The safety and efficacy of leflunomide was compared with that of methotrexate in the treatment of polyarticular juvenile rheumatoid arthritis in a multinational, randomized, controlled trial. It was concluded that in patients with polyarticular juvenile rheumatoid arthritis, methotrexate and leflunomide both resulted in high rates of clinical improvement with a slight greater rate for methotrexate.

New England States, Care and treatment, Comparative analysis, Rheumatoid arthritis in children, Juvenile rheumatoid arthritis, New England, Methotrexate, Leflunomide

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