Lyme-Arthritis

ZUSAMMENFASSUNG

Die Lyme-Arthritis ist die häufigste Spätmanifestation einer Infektion durch Borrelia burgdorferi und manifestiert sich meist als mono- oder oligoartikuläre Arthritis. Serologisch ist sie durch positive IgG-Antikörper und in der Regel negative IgM-Antikörper gegen Borrelien gekennzeichnet. Das Ansprechen auf eine initiale antibiotische Therapie (Doxycyclin oder Amoxicillin) ist in der Regel gut mit Ansprechraten von 80–90 %. Bei etwa 10 % der Patienten entwickelt sich trotz erneuter antibiotischer Therapie eine persistierende Arthritis. Bei diesem postinfektiösen („Antibiotika-refraktären“) Verlauf stehen immunopathologische Mechanismen im Vordergrund. Eine Persistenz nicht lebender Borrelienbestandteile (Peptidoglykane) scheint hierbei die Entzündung zu unterhalten. Entzündungshemmende bzw. immunmodulatorische Therapien können den postinfektiösen Verlauf der Lyme-Arthritis verkürzen. Als weitere Therapieoption kann bei refraktären Verläufen eine arthroskopische Synovektomie erwogen werden.

ABSTRACT

Lyme-arthritis is a common late manifestation of Lyme borreliosis and usually manifests as mono- or oligorticular arthritis. The serological constellation is characterized by positive IgG antibodies against borrelia with absence of IgM antibodies. Response to antibiotic therapy (initially doxycycline or amoxicillin) is usually good, with response rates of 80–90 %. In 10 % of cases, persistent arthritis develops despite repeated antibiotic treatment. In this post-infectious (“antibiotic-refractory”) course, immunopathological mechanisms are in the foreground. A persistence of avital borrelial components (peptidoglycans) also seems to maintain the inflammation. Anti-inflammatory or immunomodulatory therapies can shorten the post-infectious course of Lyme-arthritis. Arthroscopic synovectomy can be considered as a further treatment option in refractory cases.

Schlüsselwörter

Borreliose - Lyme-Arthritis - Antibiotika-refraktäre Lyme-Arthritis

Keywords

Lyme borreliosis - Lyme arthritis - Antibiotic-refractory Lyme arthritis

Publication History

Article published online:
07 June 2022

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