Gaubitz M, Dressler F, Huppertz H I, Krause A
Interdisziplinäre Diagnostik und Therapie in der Akademie für Manuelle Medizin an der WWU Münster, Von-Esmarch-Str. 50, 48149, Münster, Deutschland,
Z Rheumatol. 2014 Jun;73(5):469-74. doi: 10.1007/s00393-014-1370-7.
These guidelines summarize the current evidence for diagnosis and treatment of Lyme arthritis and the most frequent skin manifestations of Borrelia burgdorferi infections. Lyme arthritis is a monoarticular or oligoarticular form of arthritis that typically involves the knee. A positive enzyme-linked immunosorbent assay (ELISA) for IgG antibodies should be followed by an IgG immunoblot. A positive PCR test from synovial fluid adds increased diagnostic certainty. Serum positivity for antibodies to Borrelia burgdorferi without typical symptoms does not justify antibiotic treatment. Oral antibiotic treatment for erythema migrans is recommended using doxycycline, 200 mg once per day for 10-21 days, alternative choices are amoxicillin, cefuroxime and azithromycin. For children below 8 years of age, amoxicillin is recommended.Lyme arthritis can usually be successfully treated with orally administered antimicrobial agents. Doxycycline, 1 × 200 or 2 × 100 mg for 30 days is the antibiotic agent of choice. Amoxicillin (3 × 500-1000 mg) can be alternatively chosen. Patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy should be treated intravenously. In this situation, ceftriaxone at 2 g per day for 14-21 days is recommended. There is no evidence to recommend long-term and combined treatments.
本指南总结了莱姆关节炎诊断与治疗以及伯氏疏螺旋体感染最常见皮肤表现的当前证据。莱姆关节炎是一种单关节或寡关节型关节炎，通常累及膝关节。IgG抗体酶联免疫吸附测定（ELISA）结果呈阳性后，应进行IgG免疫印迹检测。滑膜液PCR检测呈阳性可增加诊断的确定性。血清中伯氏疏螺旋体抗体呈阳性但无典型症状，无需进行抗生素治疗。推荐使用多西环素治疗游走性红斑，每日1次，每次200mg，疗程10 - 21天，其他可选药物有阿莫西林、头孢呋辛和阿奇霉素。8岁以下儿童推荐使用阿莫西林。莱姆关节炎通常口服抗菌药物即可成功治疗。多西环素，每日1次，每次200mg或每日2次，每次100mg，疗程30天，为首选抗生素。也可选用阿莫西林（每日3次，每次500 - 1000mg）。在推荐疗程的口服抗生素治疗后仍有持续性或复发性关节肿胀的患者，应进行静脉治疗。在这种情况下，推荐使用头孢曲松，每日2g，疗程14 - 21天。尚无证据支持长期联合治疗。
