Lyme arthritis and periprosthetic joint infections

Arthritis is a standard complication of Lyme disease and usually presents with intermittent episodes of swelling of bigger joints, often the knee. In the meantime, periprosthetic joint infections (PJI) attributable to Lyme are uncommon.

Of their article, “Medically Managed Lyme Periprosthetic Joint Infection: A Case Report,” Saar et al. describe the case involving a affected person with acute Lyme arthritis which was difficult by a earlier whole knee arthroplasty.

A 68-year-old man residing in Virginia introduced to a medical clinic with suprapatellar swelling, ache, warmth, and delicate erythema of the left knee. “He famous ache with passive flexion and extension of the knee, in addition to a noticeable limp,” the authors state.

Twelve years earlier, the person had a complete knee arthroplasty for degenerative joint illness.

PCR testing was optimistic for Borrelia. The affected person’s left knee was drained however follow-up testing nonetheless detected Borrelia DNA.

Nonetheless, this affected person was handled efficiently with 3 months of doxycycline.

“Upon completion of 90 days of doxycycline remedy, the affected person returned for additional analysis, reporting the cessation of transient swelling and the absence of ache,” the authors state.

“Given our success with oral antibiotics, medical administration could also be a viable therapy for sufferers with acute, uncomplicated Lyme [periprosthetic joint infection],” the authors state.

Remedy of Lyme periprosthetic joint an infection

As a result of there are solely a handful of instances of PJI reported within the literature, there are not any advisable therapy pointers.

“This has left physicians attempting to mix the therapy pointers for Lyme arthritis, which is medically managed with antibiotics, and PJIs, which contain invasive surgical procedures,” the authors state.

Lyme periprosthetic joint infections are uncommon, troublesome to acknowledge and usually require surgical intervention.

Out of the 5 instances reported within the literature, 4 sufferers had been handled efficiently with surgical procedure and antibiotics, whereas only one affected person was handled efficiently with IV and oral antibiotics.

Authors Conclude:

• “When a affected person presents with atraumatic knee effusion, particularly in areas the place Lyme disease is prevalent, Lyme arthritis ought to be investigated.”
• Moreover, “given the prevalence of Lyme arthritis in areas which are endemic to Lyme disease, it might be of profit so as to add a synovial fluid PCR take a look at, the gold normal for analysis of Lyme arthritis.”
• “Medical administration of Lyme PJI could also be a viable possibility for sufferers who current with new onset signs, avoiding the chance of operative interventions.”