Lyme arthritis persisting after IV antibiotic treatment — what to do next

In some patients with Lyme arthritis, joint swelling and inflammation do not fully resolve even after completing intravenous antibiotic therapy. This protocol addresses the clinical step taken when that prior treatment has not achieved its goals.

Clinical scenario Lyme arthritis with persistent joint inflammation — the patient has not achieved resolution of arthritis signs and symptoms despite antibiotic treatment.

Previous treatment — failure condition The preceding treatment line used IV ceftriaxone, with the clinical goal of achieving full resolution of all signs and symptoms of arthritis, including joint swelling. When that goal is not reached — a process that can take many months to over a year — escalation to this protocol is indicated.

Next-line approach (partial overview) At this stage, management moves beyond antibiotic therapy and involves referral to a specialist. The full protocol specifies which categories of specialist intervention are considered and the clinical circumstances in which each applies.

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References

For patients with Lyme arthritis, we recommend using oral antibiotic therapy for 28 days (strong recommendation, moderate-quality evidence).

In patients who have failed 1 course of oral antibiotics and 1 course of IV antibiotics, we suggest a referral to a rheumatologist or other trained specialist for consideration of the use of disease modifying anti-rheumatic drugs (DMARDs), biologic agents, intraarticular steroids, or arthroscopic synovectomy (weak recommendation, very low-quality evidence).

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