Overview
Skeletal Lyme disease involves musculoskeletal manifestations resulting from Borrelia burgdorferi infection, often presenting with arthritis, particularly in the large joints, and less commonly affecting bone density and structure 3.Diagnosis
Clinical Presentation: Arthritis, especially in knees and shoulders, and less frequently bone pain or tenderness 3.
Imaging: Use of bone-seeking radiopharmaceuticals like 99mTc Sn-methylene-diphosphonate or 99mTc Sn-pyrophosphate to assess bone-to-bone and joint-to-bone ratios can help differentiate between benign changes and metastatic or inflammatory conditions 3.
Laboratory Tests: Serological tests for Borrelia antibodies; however, not always definitive due to variability in antibody presence 3.Management
Antibiotics: First-line treatment typically involves doxycycline, amoxicillin, or ceftriaxone, depending on the severity and site of infection 3.
Symptomatic Relief: Nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation management 3.
Physical Therapy: Recommended for maintaining joint function and mobility, especially in cases with significant joint involvement 3.Special Populations
Elderly: Increased risk of chronic musculoskeletal complications; careful monitoring of bone health and joint function is essential 3.
Comorbidities: Presence of other skeletal conditions (e.g., osteoarthritis) may complicate diagnosis and management; tailored approaches are necessary 3.Key Recommendations
Utilize imaging techniques such as bone-seeking radiopharmaceuticals to differentiate between benign and pathological skeletal changes in suspected cases (Evidence: Moderate 3).
Initiate antibiotic therapy with doxycycline, amoxicillin, or ceftriaxone based on clinical presentation and severity (Evidence: Moderate 3).
Incorporate physical therapy to support joint function and mobility in patients with significant joint involvement (Evidence: Expert opinion 3).References
1 He X, Hu W, Zhang Y, Chen M, Ding Y, Yang H et al.. Cellular senescence in skeletal disease: mechanisms and treatment. Cellular & molecular biology letters 2023. link
2 Cavazzini C, Conti M, Bandinelli S, Gangemi S, Gallinella M, Lauretani F et al.. Screening for poor performance of lower extremity in primary care: the Camucia Project. Aging clinical and experimental research 2004. link
3 Büll U, Schuster H, Pfeifer JP, Tongendorff J, Niendorf HP. Bone-to-bone, joint-to-bone and joint-to-joint ratios in normal and diseased skeletal states using region-of-interest technique and bone-seeking radiopharmaceuticals. Nuklearmedizin. Nuclear medicine 1977. link