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Treatment of Lyme arthritis

Behandlung der Lyme-Arthritis

  • Special Addendum — Part I
  • Therapy And Prophylaxis In Lyme Borreliosis
  • Published:
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Summary

The efficacy of different therapeutic regimens for Lyme arthritis is reviewed. The first treatment for Lyme arthritis, intramuscular benzathine penicillin 2.4 million units weekly for 3 weeks, had a success rate of 35%. Another study employed intravenous penicillin G at a dosage of 20 million units daily for 10 days, which cured 55% of patients. Intravenous ceftriaxone has been shown to be superior to penicillin with a response rate of 94%. However, these results have been challenged in recent reports. Oral doxycycline or amoxicillin in association with probenecid seems to work equally well although neuroborreliosis was more frequent following treatment with amoxicillin. An anecdotal report indicates the usefulness of long-term benzathine penicillin for chronic Lyme arthritis. Long-term antibiotic therapy, which is recommended also for Reiter's syndrome, may be useful for eradicating the sanctuaries ofBorrelia burgdorferi. Disease-modifying drugs such as hydroxychloroquine or sulphasalazine, a drug which is commonly used in reactive arthritis following enteric infections, may be of value in Lyme arthritis resistant to antibiotics but have not been tested to date. The role of intraarticular injections of steroids or synovectomy is still controversial. Antibiotic treatment is the cornerstone of Lyme arthritis treatment. Additional interventions should be studied for patients with Lyme arthritis resistant to antibiotics.

Zusammenfassung

Die Wirksamkeit verschiedener Therapieregime für die Behandlung der Lyme-Arthritis wird in einer Übersicht dargestellt. Als erster Behandlungsmodus für die Lyme-Arthritis wurde intramuskulär appliziertes Benzathinpenicillin in einer Dosierung von 2,4 Mio IE wöchentlich für drei Wochen eingesetzt. Die Erfolgrate lag bei 35%. Mit Penicillin G in einer Dosierung von 20 Mio IE i.v. täglich für 10 Tage wurden 55% der Patienten geheilt. Ceftriaxon i.v. verbesserte die Ansprechrate im Vergleich zu Penicillin auf 94%. Neuere Berichte stellen allerdings diese Ergebnisse in Frage. Vergleichbar gute Ergebnisse wurden mit oralem Doxycyclin und Amoxicillin in Kombination mit Probenecid beschrieben, doch trat nach Behandlung mit Amoxicillin häufiger eine Neuroborreliose auf. Einzelfallberichte weisen auf die Wirkung einer Langzeitbehandlung mit Benzathinpenicillin bei chronischer Lyme-Arthritis hin. Möglicherweise läßt sich durch Langzeitbehandlung mit Antibiotika wie beim Reiter-Syndrom auch eine Ausrottung vonBorrelia burgdorferi aus seinen Schlupfwinkeln erreichen. Medikamente, die den Krankheitsverlauf beeinflussen wie Hydroxychloroquin oder Sulphazalasin, das häufig zur Behandlung von reaktiven Arthritiden nach Darminfektionen eingesetzt wird, sind möglicherweise bei antibiotikaresistenter Lyme-Arthritis von Wert, doch liegen bisher keine Studien vor. Die intraartikuläre Injektion von Kortikosteroiden wird nach wie vor kontrovers diskutiert. Die Antibiotikatherapie ist der Eckstein der Behandlung der Lyme-Arthritis. Weitergehende Maßnahmen sollten bei Patienten mit antibiotikaresistenter Lyme-Arthritis geprüft werden.

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Authors and Affiliations

  1. Cattedra di Reumatologia, Dipartimento di Medicina Interna, Università di Genova, Viale Benedetto XV, 6, I-16132, Genoa, Italy

    M. A. Cimmino M. D., G. L. Moggiana M. D., Maria Parisi M. D. & S. Accardo M. D.

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  1. M. A. Cimmino M. D.
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  2. G. L. Moggiana M. D.
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  3. Maria Parisi M. D.
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  4. S. Accardo M. D.
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Cimmino, M.A., Moggiana, G.L., Parisi, M. et al. Treatment of Lyme arthritis. Infection 24, 91–94 (1996). https://doi.org/10.1007/BF01780668

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