TREATMENT OF LYME ARTHRITIS

Objective. To test treatment regimens for Lyme arthritis. Methods. Pat ients were randomly assigned to treatment with doxycycline or amoxicil lin plus probenecid for 30 days. Patients who had persistent arthritis for at least 3 months after treatment with oral antibiotics or parent eral penicillin were given intravenous ceftriaxone for 2 weeks. Result s. Eighteen of the 20 patients treated with doxycycline and 16 of the 18 patients who completed the amoxicillin regimen had resolution of th e arthritis within 13 months after study entry. However, neuroborrelio sis later developed in 5 patients, 4 of whom had received the amoxicil lin regimen. Of 16 patients (2 from the oral antibiotic study and 14 a dditional patients) who had persistent arthritis despite previous oral antibiotics or parenteral penicillin, none had resolution of the arth ritis within 3 months after ceftriaxone therapy. The HLA-DR4 specifici ty and OspA reactivity were associated with a lack of response. Conclu sion. Lyme arthritis can usually be treated successfully with oral ant ibiotics, but patients mag still develop neuroborreliosis. Patients wi th certain genetic and immune markers may have persistent arthritis de spite treatment with oral or intravenous antibiotics.