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J Rheumatol. 2019 Mar 1. pii: jrheum.180829. doi: 10.3899/jrheum.180829. [Epub ahead of print]

Intra-articular glucocorticoid injection as second-line treatment for Lyme arthritis in children.

Author information

1
From the Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research; Department of Biostatistics - Epidemiology, Rutgers School of Public Health; Department of Pediatrics, Brenner Children's Hospital, Wake Forest Baptist Medical Center; Department of Pediatrics, Penn State Milton S. Hershey Medical Center; Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania; Department of Pediatrics, Nemours/A.I. duPont Hospital for Children, Thomas Jefferson University. National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers F32-AR066461, L40-AR070497, and K23-AR070286, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under Award Number T32-HD064567. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, or the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Dr. Horton has received grant funding from Bristol-Myers Squibb for research unrelated to the present study. Dr. Rose has received grant funding from GSK for research unrelated to the present study. The other authors have no potential conflicts to disclose. Address correspondence to Daniel B. Horton, MD, MSCE 112 Paterson St, New Brunswick, NJ 08901. E-mail: daniel.horton@rutgers.edu.

Abstract

OBJECTIVE:

To determine whether second-line intra-articular glucocorticoid (IAGC) injection improves outcomes in children with persistently active Lyme arthritis after initial antibiotics.

METHODS:

We conducted an observational comparative effectiveness study through chart review within three pediatric rheumatology centers with distinct clinical approaches to second-line treatment of Lyme arthritis. We primarily compared children receiving second-line IAGCs to children receiving a second course of antibiotics alone. We evaluated the risk of developing antibiotic-refractory Lyme arthritis (ARLA) using logistic regression and the time to clinical resolution of Lyme arthritis using Cox regression.

RESULTS:

Of 112 children with persistently active Lyme arthritis after first-line antibiotics, 18 children received second-line IAGCs (13 with concomitant oral antibiotics). Compared to children receiving second-line oral antibiotics alone, children treated with IAGCs had similar baseline characteristics but lower rates of ARLA (17% vs. 44%, odds ratio 0.3 [95% CI 0.1, 0.95], P = 0.04) and faster rates of clinical resolution (hazard ratio HR 2.2 [95% CI 1.2, 3.9], P = 0.01). Children in IAGC and oral antibiotic cohorts did not differ in treatment-associated adverse events. Among children receiving second-line IAGCs, outcomes appeared similar irrespective of use of concomitant antibiotics. Outcomes were also similar between IV and oral antibiotictreated cohorts, but older children seemed to respond more favorably to IV therapy. IV antibiotics were also associated with higher rates of toxicity.

CONCLUSION:

IAGC injection appears to be an effective and safe second-line strategy for persistent Lyme arthritis in children, associated with rapid clinical resolution and reduced need for additional treatment.

PMID:
30824649
DOI:
10.3899/jrheum.180829

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