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Joint Effusions Signal Possible Lyme Arthritis

Indications of Lyme arthritis include knee involvement, willingness to bear weight

MONDAY, Feb. 14 (HealthDay News) -- Children with joint effusions in a Lyme-endemic area of the Northeastern United States may have Lyme arthritis, especially if there is knee involvement, according to a study published in the Feb. 2 issue of The Journal of Bone & Joint Surgery.

Matthew D. Milewski, M.D., from the Yale University School of Medicine in New Haven, Conn., and colleagues reviewed data from children aged 18 or younger who had joint effusions that were managed with aspiration between 1992 and 2009.

The researchers analyzed 391 patients, of whom 123 (31 percent) were later diagnosed with Lyme arthritis; whereas, 51 (13 percent) had culture-positive septic arthritis. Significant differences were seen between Lyme arthritis patients and septic arthritis patients in terms of a fever greater than 101.5 degrees Fahrenheit (40.6 degrees Celsius) at the time of presentation, dissent to bear weight, peripheral white blood-cell count, and cell count of the joint fluid. Erythrocyte sedimentation rates and the C-reactive protein levels were similar between the two groups. Multivariate analysis revealed that refusal to bear weight was the strongest predicting factor for diagnosis of septic arthritis over Lyme arthritis.

"Children presenting with joint effusions who have Lyme arthritis are more likely to have knee involvement, a lower peripheral white blood-cell count, and a lower joint fluid cell count, and they are less likely to have a high-grade fever or complete refusal to bear weight, when compared with children with septic arthritis," the authors write.

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