The Clinical Evolution of Lyme Arthritis

TLDR

The spectrum of Lyme arthritis ranges from subjective joint pain to intermittent attacks of arthritis to chronic erosive disease. The study aimed to determine the clinical evolution of Lyme arthritis. Fifty‑five patients who did not receive antibiotic therapy for erythema chronicum migrans were followed longitudinally for a mean duration of six years. Among the 55 patients, 20% remained disease‑free, 18% experienced transient pain without arthritis, 51% had intermittent large‑joint arthritis that waned over time, and 11% progressed to chronic synovitis with 4% developing erosions and 2% sustaining permanent joint disability.

Abstract

To determine the clinical evolution of Lyme arthritis, 55 patients who did not receive antibiotic therapy for erythema chronicum migrans were followed longitudinally for a mean duration of 6 years. Of the 55 patients, 11 (20%) had no subsequent manifestations of Lyme disease. From 1 day to 8 weeks after disease onset, 10 of the patients (18%) began to have brief episodes of joint, periarticular, or musculoskeletal pain for as long as 6 years, but they never developed objective joint abnormalities. From 4 days to 2 years after disease onset, 28 (51%) had one episode or began to have intermittent attacks of frank arthritis, primarily in large joints; a few had polyarticular movement. The total number of these patients who continued to have recurrences decreased by 10% to 20% each year. The remaining 6 patients (11%) developed chronic synovitis later in the illness; of these, 2 (4%) had erosions, and 1 (2%), permanent joint disability. The spectrum of Lyme arthritis ranges from subjective joint pain, to intermittent attacks of arthritis, to chronic erosive disease.