{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T01:55:35Z","timestamp":1794448535046,"version":"4.9.1"},"reference-count":33,"publisher":"The Journal of Rheumatology","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To determine whether second-line intraarticular glucocorticoid (IAGC) injection improves outcomes in children with persistently active Lyme arthritis after initial antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>We conducted an observational comparative effectiveness study through chart review within 3 pediatric rheumatology centers with distinct clinical approaches to second-line treatment of Lyme arthritis. We primarily compared children receiving second-line IAGC to children receiving a second course of antibiotics alone. We evaluated the risk of developing antibiotic-refractory Lyme arthritis (ARLA) using logistic regression and the time to clinical resolution of Lyme arthritis using Cox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Of 112 children with persistently active Lyme arthritis after first-line antibiotics, 18 children received second-line IAGC (13 with concomitant oral antibiotics). Compared to children receiving second-line oral antibiotics alone, children treated with IAGC had similar baseline characteristics but lower rates of ARLA (17% vs 44%; OR 0.3, 95% CI 0.1\u20130.95; p = 0.04) and faster rates of clinical resolution (HR 2.2, 95% CI 1.2\u20133.9; p = 0.01). Children in IAGC and oral antibiotic cohorts did not differ in treatment-associated adverse events. Among children receiving second-line IAGC, outcomes appeared similar irrespective of use of concomitant antibiotics. Outcomes were also similar between intravenous (IV) and oral antibiotic-treated cohorts, but older children seemed to respond more favorably to IV therapy. IV antibiotics were also associated with higher rates of toxicity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>IAGC injection appears to be an effective and safe second-line strategy for persistent Lyme arthritis in children, associated with rapid clinical resolution and reduced need for additional treatment.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.180829","type":"journal-article","created":{"date-parts":[[2019,3,1]],"date-time":"2019-03-01T17:25:45Z","timestamp":1551461145000},"page":"952-959","source":"Crossref","is-referenced-by-count":20,"title":["Intraarticular Glucocorticoid Injection as Second-line Treatment for Lyme Arthritis in Children"],"prefix":"10.3899","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1831-1339","authenticated-orcid":false,"given":"Daniel B.","family":"Horton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alysha J.","family":"Taxter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3660-7627","authenticated-orcid":false,"given":"Amy L.","family":"Davidow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandt P.","family":"Groh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David D.","family":"Sherry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos D.","family":"Rose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2019,3,1]]},"reference":[{"key":"2019080109250520000_46.8.952.1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2108.141878"},{"key":"2019080109250520000_46.8.952.2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6717e1"},{"key":"2019080109250520000_46.8.952.3","doi-asserted-by":"publisher","DOI":"10.1159\/000213069"},{"key":"2019080109250520000_46.8.952.4","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-107-5-725"},{"key":"2019080109250520000_46.8.952.5","doi-asserted-by":"publisher","DOI":"10.1542\/peds.102.4.905"},{"key":"2019080109250520000_46.8.952.6","doi-asserted-by":"publisher","DOI":"10.1038\/nri1267"},{"key":"2019080109250520000_46.8.952.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780370616"},{"key":"2019080109250520000_46.8.952.8","doi-asserted-by":"publisher","DOI":"10.1007\/s00508-005-0361-8"},{"key":"2019080109250520000_46.8.952.9","doi-asserted-by":"publisher","DOI":"10.1086\/508667"},{"key":"2019080109250520000_46.8.952.10","doi-asserted-by":"crossref","unstructured":"Lyme disease. 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