TY - JOUR
T1 - The Value of Musculoskeletal Ultrasound for Evaluation of Postinfectious Lyme Arthritis
AU - Miller, John B.
AU - Albayda, Jemima
AU - Aucott, John N.
N1 - Funding Information:
Research reported in this publication was supported in part by the National Institutes of Arthritis and Musculoskeletal and Skin Diseases (P30-AR070254 Core B), the Jerome L. Greene Foundation and Cupid Foundation to J.A., and the Ira T Fine Discovery Fund to J.B.M.
Publisher Copyright:
© Wolters Kluwer Health, Inc. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Background Inflammatory arthritis is the most common late manifestation of untreated Lyme disease in the United States. While antimicrobial therapy is effective in resolving swelling and pain for 90% of patients, many patients have persistent inflammation, termed postinfectious Lyme arthritis (PILA). Current outcome measures for Lyme arthritis have several limitations, as improvement is considered a dichotomous outcome based solely on physical examination. There is growing interest in the use of ultrasonography to better define outcomes in inflammatory arthritis, and this is particularly relevant for conditions such as late Lyme arthritis and PILA, which are monoarticular or oligoarticular. We describe results from a series of 5 patients who underwent ultrasound evaluations leading to a diagnosis of PILA. Methods This is a case series describing 5 patients with PILA who were referred for evaluation and treatment of symptomatic joints. Results Musculoskeletal ultrasound showed significant joint pathology, even in cases with minimal clinical findings. Synovitis, effusions, enthesitis/tendinopathy, and bone erosions were seen and helped confirm the presence of ongoing inflammatory arthritis. Conclusions Marked inflammatory change - with synovitis, enthesitis and erosions - can be seen in selected patients with PILA. Systematic sonographic evaluation of patients with PILA is needed to further evaluate pathology and treatment response.
AB - Background Inflammatory arthritis is the most common late manifestation of untreated Lyme disease in the United States. While antimicrobial therapy is effective in resolving swelling and pain for 90% of patients, many patients have persistent inflammation, termed postinfectious Lyme arthritis (PILA). Current outcome measures for Lyme arthritis have several limitations, as improvement is considered a dichotomous outcome based solely on physical examination. There is growing interest in the use of ultrasonography to better define outcomes in inflammatory arthritis, and this is particularly relevant for conditions such as late Lyme arthritis and PILA, which are monoarticular or oligoarticular. We describe results from a series of 5 patients who underwent ultrasound evaluations leading to a diagnosis of PILA. Methods This is a case series describing 5 patients with PILA who were referred for evaluation and treatment of symptomatic joints. Results Musculoskeletal ultrasound showed significant joint pathology, even in cases with minimal clinical findings. Synovitis, effusions, enthesitis/tendinopathy, and bone erosions were seen and helped confirm the presence of ongoing inflammatory arthritis. Conclusions Marked inflammatory change - with synovitis, enthesitis and erosions - can be seen in selected patients with PILA. Systematic sonographic evaluation of patients with PILA is needed to further evaluate pathology and treatment response.
KW - Lyme arthritis
KW - inflammatory arthritis
KW - ultrasonography
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U2 - 10.1097/RHU.0000000000001732
DO - 10.1097/RHU.0000000000001732
M3 - Article
C2 - 33790205
AN - SCOPUS:85125018462
SN - 1076-1608
VL - 28
SP - E605-E608
JO - Journal of Clinical Rheumatology
JF - Journal of Clinical Rheumatology
IS - 2
ER -