New Study Explores Operative Versus Nonoperative Therapy in Cases of Lyme Arthritis

A team of researchers from UPMC Children’s Hospital of Pittsburgh Divisions of Pediatric Infectious Diseases and Pediatric Orthopaedic Surgery published a new study on the impact of operative intervention in cases of pediatric Lyme arthritis. The study was published in December 2021 in the Journal of Pediatric Orthopaedics. Contributing to the investigation was Michael P. McClincy, MD, assistant professor of Orthopaedic Surgery.

“As the incidence of tick-borne Lyme disease continues to explode in various parts of the United States, in particular the mid-Atlantic and Northeast regions, the incidence of Lyme arthritis will likely increase. However, as with Lyme disease in general, Lyme arthritis is often very difficult to distinguish from septic arthritis, the latter of which typically must be treated surgically,” says Dr. McClincy. “Our team was interested in outcomes of Lyme arthritis in pediatric patients, comparing those treated surgically with those treated medically.”

To assess comparative outcomes, the research team reviewed Lyme arthritis cases diagnosed at UPMC Children’s between 2008 and 2018.

The chart analysis uncovered 149 cases of diagnosed Lyme arthritis. This cohort was divided into cases treated only with antibiotic therapy and those treated with surgical debridement in addition to antibiotic therapy.

The main finding from the study is that clinical outcomes in both cohorts were similar in nature. However, as one would expect, the costs associated with treatment for the surgical cohort were higher, and the surgical cohort had longer lengths of hospital admission.

“Lyme often can be an insidious disease with perplexing or nondescript symptoms, or symptoms that masquerade as something different. If our outcomes research holds up with further investigations and studies, it could help us avoid unnecessary surgical interventions in this population, which would have numerous benefits,” says Dr. McClincy. “Given how prevalent Lyme is now, and given the projections for its increased spread, we should remain vigilant and diligently pursue better ways to differentiate Lyme arthritis from other types, and work to further study optimal management strategies.”

Collaborating with Dr. McClincy include senior author Brian Campfield, MD, assistant professor of Pediatrics in the Division of Pediatric Infectious Diseases and scholar at the Richard King Mellon Foundation Institute for Pediatric Research; Andrew J. Nowalk MD, PhD, associate professor of Pediatrics and clinical director of Infectious Disease at UPMC Children’s; Andrew R. Tout, BS from the Division of Infectious Diseases; and Alyce Anderson, MD, PhD.

Learn more and read the full study using the below reference.

Reference

Tout AR, McClincy M, Anderson A, Nowalk A, Campfield BT. The Impact of Operative Intervention in Pediatric Lyme Arthritis. J Pediatr Orthop. 2021 Nov-Dec 01; 41(10): e911-e916.