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Childhood Arthritis: Common, but Preventable, Consequence of Lyme Disease

Early detection is key to preventing lasting complications seen frequently at Hospital for Special Surgery

NEW YORK—June 26, 2009

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. 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.
    • Any suspicious rashes should be evaluated by a physician.
    • 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.
    • 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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.


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