Lyme Arthritis: A Comparison of Presentation, Synovial Fluid Analysis, and Treatment Course in Children and Adults
Lyme Arthritis: A Comparison of Presentation, Synovial Fluid Analysis, and Treatment Course in Children and Adults
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DOI：
10.1002/acr.22086
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发表时间：
2013-12-01
影响因子：
4.7
通讯作者：
McCarthy, Carol A.
中科院分区：
文献类型：
--
作者：
Daikh, Brian E.;Emerson, Fred E.;McCarthy, Carol A.
这一系列的情况下，探讨在演示文稿中的差异，管理，和儿童和成人population.MethodsWe莱姆病关节炎的结果评估的风湿病学家和儿科传染病专家在波特兰，缅因州之间的2002年1月和2008年7月的儿科和成人患者的图表。纳入分析的患者记录了关节肿胀和阳性莱姆病血清学。临床表现，滑液和外周血结果，治疗和临床course.Results29成人和52名儿童符合莱姆病关节炎的情况下标准的数据进行了分析。与成人相比，儿童更容易急性发作（P < 0.0001），并且平均外周血（P = 0.05）和滑液白色血细胞计数（P < 0.0001）也更高。莱姆关节炎更常见于儿童（P = 0.04）。儿童和成人在怀疑感染性关节炎、住院或手术干预方面没有差异。成人接受更多的抗生素疗程（P = 0.007），更有可能在随后的治疗疗程中静脉注射抗生素（P = 0.006）。儿童更有可能有正常的功能在4周内开始抗生素治疗（P < 0.0001）。结论儿童莱姆关节炎更容易出现急性高滑膜白色细胞计数比成人。然而，我们没有观察到住院或手术治疗的显著差异。儿童的关节肿胀得到了更迅速的解决，总体上接受了更少的治疗。
ObjectiveThis case series examines differences in the presentation, management, and outcome of Lyme arthritis between the pediatric and adult population.MethodsWe reviewed charts of pediatric and adult patients evaluated for Lyme arthritis by rheumatologists and pediatric infectious disease specialists in Portland, Maine between January 2002 and July 2008. Patients included for analysis had documented joint swelling and positive Lyme serology. Data on clinical presentation, synovial fluid and peripheral blood results, treatment, and clinical course were analyzed.ResultsTwenty-nine adults and 52 children met case criteria for Lyme arthritis. Children were more likely than adults to present acutely (P < 0.0001) and also had higher mean peripheral blood (P = 0.05) and synovial fluid white blood cell counts (P < 0.0001). Lyme arthritis was more frequently suspected in children at presentation (P = 0.04). There was no difference between children and adults with respect to suspicion for septic arthritis, hospitalization, or surgical intervention. Adults received more antibiotic courses (P = 0.007) and were more likely to have intravenous antibiotics in subsequent treatment courses (P = 0.006). Children were more likely to have normal function within 4 weeks of initiating antibiotic treatment (P < 0.0001).ConclusionChildren with Lyme arthritis were more likely to present acutely with higher synovial white cell counts than adults. We did not, however, observe a significant difference in hospitalization or surgical management. Children had more prompt resolution of their joint swelling and received less treatment overall.