Although DMARDs stronger than hydroxychloroquine were used in the investigation, “we're reluctant to recommend them, both because our limited experience with them doesn't prove efficacy and because of the possibility that they may be given to patients in whom the infection is still active,” Dr. Steere noted.
Because Lyme arthritis eventually resolves even without antibiotic therapy, Dr. Steere and colleagues also sought to determine whether antibiotic treatment altered the natural course of the disease in patients with antibiotic-refractory arthritis.
To do this, they compared the current findings to those of 21 patients treated for Lyme arthritis in the late 1970s “before the etiologic agent of Lyme disease was known,” Dr. Steere said. That group of patients received NSAIDs and intra-articular steroids, but not antibiotics, and experienced episodes of arthritis for a median period of 43 months.
In contrast, the median total time of arthritis episodes for the antibiotic-responsive patients and the antibiotic-refractory patients in the current study was 4 and 16 months, respectively. The finding suggests “antibiotic therapy decreases the period of joint inflammation, even in patients with antibiotic-refractory arthritis,” he said.