Musculoskeletal manifestations of Lyme disease in children

Although the clinical spectrum of Lyme Borreliosis includes manifestations in multiple organ systems, initial descriptions of the disease were of arthritis, which remains the most important late manifestation of the disease in children. Arthralgia, myalgia and a fibromyalgia syndrome are other musculoskeletal manifestations of infection with Borrelia burgdorferi in children. Lyme arthritis is usually intermittent, with each episode lasting less than 2 weeks. Most children, whether treated or not, do not develop chronic arthritis simulating juvenile rheumatoid arthritis. Factors which are related to likelihood of developing chronic arthritis are age, sex, duration of symptoms before treatment, and HLA type. The immunopathogenesis, immunodiagnosis, musculoskeletal manifestations of the disease, its therapy, and implications of Lyme disease as a model to understand chronic rheumatic diseases in general, are discussed.