Second-line IAGC injection safe, effective for persistent Lyme arthritis in children
Intra-articular glucocorticoid (IAGC) injection is associated with rapid clinical resolution and reduced need for additional treatment, making it an effective and safe second-line strategy for persistent Lyme arthritis in children, a recent study has shown.
Eighteen of the 112 children with persistently active Lyme arthritis after first-line antibiotics were treated with second-line IAGC (13 with concomitant oral antibiotics).
Compared to children treated with second-line oral antibiotics, those who received IAGC had similar baseline characteristics but lower rates of antibiotic-refractory Lyme arthritis (ARLA; 17 percent vs 44 percent; odds ratio, 0.3, 95 percent CI, 0.1–0.95; p=0.04) and faster rates of clinical resolution (hazard ratio, 2.2, 1.2–3.9; p=0.01).
Treatment-related adverse events were similar between children in IAGC and those on oral antibiotics.
Outcomes were similar among children treated with second-line IAGC regardless of concomitant antibiotics use. Intravenous and oral antibiotic-treated cohorts also showed similar outcomes, but older children appeared to be more favourably responsive to IV therapy. However, IV antibiotics correlated with higher toxicity rates.
This study sought to determine whether second-line IAGC injection improved outcomes in children with persistent Lyme arthritis after initial antibiotics. An observational comparative effective study was conducted through chart review within three paediatric rheumatology centres with distinct clinical approaches to second-line treatment of Lyme arthritis.
Children treated with second-line IAGC were compared to those receiving a second course of antibiotics monotherapy. The authors examined the risk of developing ARLA using logistic regression and the time to clinical resolution of Lyme arthritis using Cox regression.