Steroids for Lyme Disease: When Are Steroid Injections Appropriate for Lyme Arthritis?
Persistent Lyme arthritis after antibiotics
When steroid injections may be considered
What a pediatric study found
Steroids are generally avoided during active Lyme disease because they may suppress the immune response to infection. However, once appropriate antibiotic treatment has been completed, some specialists consider intra-articular steroid injections for children with persistent Lyme arthritis. A pediatric study by Horton and colleagues examined whether this approach could improve recovery after an initial course of antibiotics.
Oral corticosteroids such as prednisone and local corticosteroid (cortisone) injections both reduce inflammation, but neither treats the underlying Borrelia burgdorferi infection. Treatment decisions should be individualized based on the patient’s clinical presentation and stage of illness.
Why are steroids usually avoided during active Lyme disease?
Premature use of corticosteroids has been reported as a potential risk factor for developing antibiotic-refractory Lyme arthritis (ARLA) in children and adults.1 Horton and colleagues note that this concern is attributed to local immune suppression within an infected joint, which may impair the body’s ability to eliminate the infection.
For this reason, many clinicians reserve corticosteroids for carefully selected patients after appropriate antibiotic treatment has been completed rather than during active infection.
Earlier reports suggested that steroid treatment before adequate antibiotic therapy could increase the risk of antibiotic-refractory Lyme arthritis. Horton and colleagues therefore examined whether steroid injections given only after an initial course of antibiotics might produce different results.
What did the pediatric study find?
Horton and colleagues evaluated children with persistent Lyme arthritis who continued to have joint inflammation after completing an initial course of antibiotics.
The investigators compared 18 children treated with second-line intra-articular glucocorticoid (IAGC) injections with children who received a second course of antibiotics alone.
Children who received steroid injections experienced lower rates of antibiotic-refractory Lyme arthritis (17% versus 44%) and faster symptom resolution than those treated with another course of antibiotics alone.
The authors concluded that intra-articular glucocorticoid injections appeared to be an effective and safe second-line treatment strategy for persistent Lyme arthritis in children and were associated with more rapid clinical improvement and a reduced need for additional treatment.
“IAGC injection appears to be an effective and safe second-line strategy for persistent Lyme arthritis in children.”
However, because this was a small observational study rather than a randomized clinical trial, the findings should be interpreted cautiously. Larger studies are needed to confirm these results.
Whether these findings apply equally to adults remains uncertain.
Frequently Asked Questions
Can prednisone help Lyme disease?
Prednisone and other corticosteroids reduce inflammation but do not treat Borrelia burgdorferi, the bacterium that causes Lyme disease. During active infection, steroids are generally used cautiously because they may suppress the immune response.
Are steroid injections safe for Lyme arthritis?
This pediatric study suggests that carefully selected children with persistent Lyme arthritis after antibiotic treatment may benefit from intra-articular steroid injections. Additional studies are needed before this approach can be broadly recommended.
Can cortisone injections help Lyme arthritis?
A small pediatric study suggests that carefully selected children with persistent Lyme arthritis after antibiotic treatment may benefit from intra-articular corticosteroid injections. Larger studies are needed, and treatment decisions should be individualized.
Why are steroids controversial in Lyme disease?
The concern is that corticosteroids may reduce the body’s ability to fight an active infection. Their use should therefore be individualized based on the patient’s clinical situation.
Clinical Takeaway
This study suggests that intra-articular steroid injections may benefit carefully selected children with persistent Lyme arthritis after an initial course of antibiotics. It does not establish that corticosteroids should be used during active Lyme disease or address their potential effects on other short- or long-term manifestations of Lyme disease.
In my practice, I generally avoid corticosteroids unless there is a clear clinical indication and the potential benefits outweigh the risks.
Related Articles
Steroid use can lead to long-term treatment failure for Lyme disease patients
Preventing unnecessary surgery for children with Lyme arthritis
Lyme arthritis: symptoms, diagnosis, and treatment
References
- Horton DB, Taxter AJ, Davidow AL, Groh B, Sherry DD, Rose CD. Intra-articular glucocorticoid injection as second-line treatment for Lyme arthritis in children. J Rheumatol. 2019;46(10):1387-1394.
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
