Algorithm for the Diagnosis and Treatment of Arthritis Associated with Lyme Disease - Flowchart
Algorithm for the Diagnosis and Treatment of Arthritis Associated with Lyme Disease - Flowchart Lyme Disease Lyme Disease
«Flowchart»

DIAGNOSIS AND TREATMENT OF LYME ARTHRITIS

DIAGNOSIS AND TREATMENT OF LYME ARTHRITIS

DIAGNOSIS AND TREATMENT OF LYME ARTHRITIS

DIAGNOSIS AND TREATMENT OF LYME ARTHRITIS

Repeat oral antibiotic regimen for another 30 days

Repeat oral antibiotic regimen for another 30 days

Repeat oral antibiotic regimen for another 30 days


IV ceftriaxone, 2 g daily
IV cefotaxime, 2 g three times daily
IV penicillin G, 20 million U in 6 divided doses daily, in each instance, for 30 days


IV ceftriaxone, 2 g daily
IV cefotaxime, 2 g three times daily
IV penicillin G, 20 million U in 6 divided doses daily, in each instance, for 30 days


IV ceftriaxone, 2 g daily
IV cefotaxime, 2 g three times daily
IV penicillin G, 20 million U in 6 divided doses daily, in each instance, for 30 days


IV ceftriaxone, 2 g daily
IV cefotaxime, 2 g three times daily
IV penicillin G, 20 million U in 6 divided doses daily, in each instance, for 30 days


Patient with monoarticular or oligoarticular arthritis, especially of a knee
Positive IgG antibody response to B. burgdorferi by ELISA and Western blot
Optional: Positive PCR result for B. burgdorferi DNA in joint fluid


Patient with monoarticular or oligoarticular arthritis, especially of a knee
Positive IgG antibody response to B. burgdorferi by ELISA and Western blot
Optional: Positive PCR result for B. burgdorferi DNA in joint fluid


Patient with monoarticular or oligoarticular arthritis, especially of a knee
Positive IgG antibody response to B. burgdorferi by ELISA and Western blot
Optional: Positive PCR result for B. burgdorferi DNA in joint fluid


Patient with monoarticular or oligoarticular arthritis, especially of a knee
Positive IgG antibody response to B. burgdorferi by ELISA and Western blot
Optional: Positive PCR result for B. burgdorferi DNA in joint fluid B. burgdorferi B. burgdorferi
B. burgdorferi B. burgdorferi

Initial treatment

Initial treatment

Initial treatment


Oral doxycycline, 100 mg twice daily for 30 days
Oral amoxicillin, 500 mg three times daily for 30 days
In cases with concomitant neurologic involvement, use IV regimens


Oral doxycycline, 100 mg twice daily for 30 days
Oral amoxicillin, 500 mg three times daily for 30 days
In cases with concomitant neurologic involvement, use IV regimens


Oral doxycycline, 100 mg twice daily for 30 days
Oral amoxicillin, 500 mg three times daily for 30 days
In cases with concomitant neurologic involvement, use IV regimens


Oral doxycycline, 100 mg twice daily for 30 days
Oral amoxicillin, 500 mg three times daily for 30 days
In cases with concomitant neurologic involvement, use IV regimens

Mild persistent arthritis after 30 days of therapy

Mild persistent arthritis after 30 days of therapy

Mild

Moderate to severe persistent arthritis after 30 days of therapy

Moderate to severe persistent arthritis after 30 days of therapy

Moderate to severe

End

End

End

Persistent arthritis after 60 days of antibiotics, including 30 days of IV therapy

Persistent arthritis after 60 days of antibiotics, including 30 days of IV therapy

Persistent arthritis after 60 days of antibiotics, including 30 days of IV therapy

If arthritis still persists, add NSAID and/or DMARD, such as hydroxychloroquine or methotrexate

If arthritis still persists, add NSAID and/or DMARD, such as hydroxychloroquine or methotrexate

If arthritis still persists, add NSAID and/or DMARD, such as hydroxychloroquine or methotrexate

If arthritis persists for 3 to 6 more mo

If arthritis persists for 3 to 6 more mo

If arthritis persists for 3 to 6 more mo

Consider arthroscopic synovectomy

Consider arthroscopic synovectomy

Consider arthroscopic synovectomy