Thompson Amy, Mannix Rebekah, Bachur Richard
Children's Hospital Boston, Division of Emergency Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2009 Mar;123(3):959-65. doi: 10.1542/peds.2008-1511.
Identify clinical predictors of Lyme arthritis among patients with acute monoarticular arthritis.
A medical chart review was conducted of children </=18 years of age with monoarticular arthritis who underwent arthrocentesis in a pediatric emergency department located in the northeast United States. Patients were classified into 3 categories of arthritis: septic, Lyme, or nonseptic non-Lyme arthritis. Historical, clinical, and laboratory data were compared to identify distinguishing features of Lyme arthritis.
One hundred seventy-nine patients were studied: 46 (26%) patients with septic arthritis, 55 (31%) patients with Lyme arthritis, and 78 (43%) patients with nonseptic non-Lyme arthritis. Compared with those with septic arthritis, patients with Lyme disease were more likely to have a tick-bite history, knee involvement, and less likely to have a history of fever or elevated temperature at triage. Erythrocyte sedimentation rate, C-reactive protein, joint white blood cell count, and joint neutrophil percentage were also statistically lower. In comparison to nonseptic non-Lyme arthritis, knee involvement and tick-bite history were predictors of Lyme. Erythrocyte sedimentation rate, joint white blood cell count, and joint neutrophil percentage were also statistically different. Multivariate analysis comparing Lyme to septic arthritis demonstrated fever history and elevated C-reactive protein level to be negative predictors of Lyme arthritis and knee involvement to be a positive predictor (model sensitivity: 88%; specificity: 82%).
Lyme arthritis shares features with both septic and nonseptic non-Lyme arthritis. This overlap prevents the creation of a clinically useful predictive model for Lyme arthritis. In endemic areas, Lyme testing should be performed on all patients presenting with acute monoarticular arthritis.
确定急性单关节关节炎患者中莱姆关节炎的临床预测因素。
对美国东北部一家儿科急诊科接受关节穿刺术的18岁及以下单关节关节炎儿童进行病历回顾。患者被分为3类关节炎：脓毒性关节炎、莱姆关节炎或非脓毒性非莱姆关节炎。比较病史、临床和实验室数据，以确定莱姆关节炎的特征。
共研究了179例患者：46例（26%）脓毒性关节炎患者，55例（31%）莱姆关节炎患者，78例（43%）非脓毒性非莱姆关节炎患者。与脓毒性关节炎患者相比，莱姆病患者更可能有蜱叮咬史、膝关节受累，且在分诊时发热或体温升高的可能性更小。红细胞沉降率、C反应蛋白、关节白细胞计数和关节中性粒细胞百分比在统计学上也更低。与非脓毒性非莱姆关节炎相比，膝关节受累和蜱叮咬史是莱姆病的预测因素。红细胞沉降率、关节白细胞计数和关节中性粒细胞百分比在统计学上也有差异。比较莱姆关节炎与脓毒性关节炎的多变量分析显示，发热史和C反应蛋白水平升高是莱姆关节炎的负性预测因素，膝关节受累是正性预测因素（模型敏感性：88%；特异性：82%）。
莱姆关节炎兼具脓毒性关节炎和非脓毒性非莱姆关节炎的特征。这种重叠使得无法建立一个对莱姆关节炎临床有用的预测模型。在流行地区，应对所有急性单关节关节炎患者进行莱姆病检测。
