American College of Rheumatology – Pediatric Rheumatology

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Released October 27, 2013

Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.

The musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia or intermittent or persistent episodes of arthritis in one or a few large joints at a time, especially the knee. Lyme testing in the absence of these features increases the likelihood of false positive results and may lead to unnecessary follow-up and therapy. Diffuse arthralgias, myalgias or fibromyalgia alone are not criteria for musculoskeletal Lyme disease.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The American College of Rheumatology (ACR) used a multi-stage process combining consensus methodology and literature reviews to arrive at its Pediatric Rheumatology Top 5 list. Items were generated by a group of practicing pediatric rheumatologists using the Delphi method. Items with high content agreement and perceived prevalence advanced to a survey of ACR members who listed pediatric rheumatology as their specialty. Based on member input related to content agreement, impact and item ranking, candidate items advanced to literature review. The ACR Special Committee on Pediatric Rheumatology discussed the items in light of their relevance to rheumatology, level of evidence to support their inclusion in the final list and the member survey results, and drafted the final pediatric rheumatology Top 5 list. The list was reviewed and approved by the ACR Board of Directors.

ACR’s disclosure and conflict of interest policy can be found at www.rheumatology.org.

ACR Special Committee on Pediatric Rheumatology

  • Polly Ferguson, MD, Chair – University of Iowa Carver College of Medicine, Iowa City, IA
  • Stacy Ardoin, MD – Ohio State University, Columbus, OH
  • Mara Becker, MD – Children’s Mercy Hospital, Kansas City, MO
  • Ashley Cooper, MD – University of Texas Southwestern Medical School, Dallas, TX
  • Leonard Dragone, MD, PhD – National Jewish Hospital, Denver, CO
  • Anna Huttenlocher, MD – University of Wisconsin Medical School, Madison, WI
  • Karla Jones, RN, MS, CPNP – Nationwide Children’s Hospital, Columbus, OH
  • Karen Kolba, MD – Pacific Arthritis Center, Santa Maria, CA
  • Lakshmi Moorthy, MD, MS – Robert Wood Johnson Medical School, New Brunswick, NJ
  • Peter Nigrovic, MD – Brigham and Women’s Hospital, Boston, MA
  • Kelly Rouster-Stevens, MD – Emory Children’s Center, Atlanta, GA
  • Jennifer Stinson, RN, PhD, CPNP – The Hospital for Sick Children, Toronto, ON, CA

American College of Rheumatology Pediatric Rheumatology Core Membership Group*

* Members of the Core Membership Group included: Robert Colbert, MD, PhD, Randy Cron, MD, PhD, Peter Dent, MD, Melissa Elder, MD, PhD, Don Goldsmith, MD, Roger Hollister, MD, Norman Ilowite, MD, Yukiki Kimura, MD, Marisa Klein-Gittelman, MD, MPH, Erica Lawson, MD, Murray Passo, MD, Ross Petty, MD, PhD, Marilynn Punaro, MD, Egla Rabinovich, MD, MPH, Andreas Reiff, MD, David Sherry, MD, Larry Zemel, MD.

Sources

Lyme Disease Diagnosis and Treatment. [Internet]. Atlanta (GA). Centers for Disease Control and Prevention. [Updated 2011 Nov 15; cited 2012 Sep 6]. Available from:www.cdc.gov/lyme/diagnosistreatment/index.html.

American College of Physicians. Guidelines for laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med. 1997;127(12):1106–8.

Hu LT. Lyme disease. Ann Intern Med. 2012;157(3):ITC2-1.

Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089–134.