Do Steroid Injections Help Children With Lyme Arthritis of the Knee?

Steroid injections may help some children with persistent Lyme arthritis—but timing and clinical context matter.

Premature use of steroids “has been reported as a potential risk factor for the development of antibiotic-refractory Lyme arthritis (ARLA) in children and adults,” writes Horton et al. [1]

This risk is attributed to local immune suppression within an infected joint, potentially impairing the body’s ability to clear infection.

Study Examines Steroid Injections in Children

Horton and colleagues evaluated whether intra-articular glucocorticoid (IAGC) injections could benefit children with persistent Lyme arthritis after an initial course of antibiotics.

The study included 18 children who received steroid injections after failing first-line antibiotic therapy. Outcomes were compared with children treated with a second course of antibiotics alone.

Key Findings

• Lower rates of antibiotic-refractory Lyme arthritis: 17% vs. 44%
• Faster symptom resolution in the steroid group
• Reduced need for additional treatment

Based on these findings, the authors conclude that intra-articular steroid injections may be an effective second-line strategy in selected pediatric cases.

Clinical Considerations

While these results are encouraging, the study was small and observational.

Importantly, early or inappropriate steroid use may worsen outcomes by suppressing the immune response during active infection.

Learn more about Lyme arthritis and how treatment decisions are made in complex cases.

In clinical practice, careful patient selection and timing are essential.

Clinical Perspective

In my practice, I generally avoid steroids in Lyme disease unless clearly indicated.

This study raises an important possibility—that steroid injections may have a role in carefully selected children with persistent arthritis—but additional research is needed to clarify long-term outcomes.

Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention