Childhood Arthritis: Common but Preventable Consequence of Lyme Disease

When left untreated, children infected with Lyme disease can experience many severe complications as a result including arthritis, problems with the heart or central nervous system.

Lyme disease in children is often overlooked in its earliest stages, leading to these complications later on, according to Emma Jane MacDermott, M.D., pediatric rheumatologist at Hospital for Special Surgery in New York. This problem is particularly common in the Northeast: the ticks that carry the disease are found in this area and up to 90 percent of the cases occur here.

After the initial exposure, which occurs when a tick bites an infected animal — usually a deer or a mouse — and then feeds on a child, the disease is considered to be in its early stage. Lyme disease first presents with a rash occurring at the site of the tick bite. 

“This rash may be completely red, but usually develops a pale area in the center that makes it look like a bull’s eye,” said Dr. MacDermott. “Symptoms of early disease occur within days or weeks of the bite and resemble the flu. In fact, early disease is often dismissed as a viral infection in children and therefore not treated.”

Children can progress to ‘late disease’ if their illness is not recognized and treated, often many months later. “This can involve the heart, nervous system and very commonly the joints,” explained Dr. MacDermott. “More than half of untreated patients may develop arthritis and Lyme arthritis can affect any joint. Arthritis often involves one large joint, usually the knee, which rapidly becomes markedly swollen and painful, but symptoms may be more subtle.”

That is why, according to Dr. MacDermott, it is important for children to get tested for the disease when suspicious symptoms first occur, before the illness gets a chance to progress to its late stage. The blood test for Lyme disease involves two steps: “First, a screening test is performed that is very sensitive and detects any organisms including those causing Lyme disease, but also many others that occur normally. The second phase of the Lyme test, known as a Western blot, is done on all patients with positive results,” she continued.

Once a diagnosis is confirmed, treatment should be swift to prevent further complications. “Treatment is with antibiotics and the type used depends on the age of the child and any allergies,” said Dr. MacDermott. “The duration of treatment differs based on the stage of the disease, a longer course being given if patients have late symptoms. Sometimes fluid can be removed from a swollen, painful joint to give symptomatic relief, and anti-inflammatories can be given to help patients feel better.”

Arthritic symptoms and joint problems may continue despite treatment. “A small proportion of children continue to have some symptoms despite extensive antibiotic treatment,” said Dr. MacDermott. This is thought to be an expression of persistent stimulation of the inflammatory system and not the continued presence of the disease, and as such is best treated with the battery of medications that are used for inflammation, according to Dr. MacDermott.

To prevent lasting complications of Lyme disease, awareness and early detection are key. Here are some tips for parents to keep their children in the clear:
• Check children for ticks, particularly during summer months.
• Children displaying symptoms should be tested and treated appropriately.
o Any suspicious rashes should be evaluated by a physician.
o Don’t ignore unexplained joint complaints.
• For a child who has been found with an embedded tick, but has displayed no symptoms, a Lyme test should be performed.
o It is considered appropriate to begin medication, which can be stopped if repeat Lyme testing is negative.
• Always ask your physician if you have any questions or concerns.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics and No. 4 in rheumatology by U.S. News & World Report (2008), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In 2008 and 2007, HSS was a recipient of the HealthGrades Joint Replacement Excellence Award. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Cornell Medical College. The hospital’s research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases.

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