American Academy of Pediatrics – Section on Rheumatology
View all recommendations from this societyAugust 6, 2019
Do not test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history or appropriate exam findings.
The musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia with early disseminated Lyme and/or intermittent or persistent episodes of arthritis in one or a few large joints, with predilection for the knee, in late disease. Lyme testing in the absence of these features and without appropriate exposure from living in or traveling to a Lyme endemic area 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 Academy of Pediatrics’ Section on Rheumatology (SORh) consists of pediatric rheumatologists, pediatricians, and allied health care professionals who are actively involved in some aspect of the study of rheumatologic disease in children and adolescents. The SORh strives to inform pediatricians, parents, communities, and policy makers on rheumatic disease in children. The fellow members of the SORh were queried to develop a list of diagnostic and management decisions that have resulted in misuse of laboratory studies and resources. Through a series of votes, the fellow members developed the list into five statements to address the most common misconceptions seen when encountering pediatric autoimmune conditions. The fellows involved in this project are: Kathleen Collins, Brian Dizon, Suhas Ganguli, Miriah Gillispie, Marla Guzman, Michael B. Nelson, Onengiya Harry, Meiqian Ma, MaiLan Nguyen, Amir Orandi, Amanda Schlefman, Laura Tasan, and Erin Treemarcki. The list was shared with membership of the SORh Executive Committee for feedback and then finalized by collaboration. These five clinical issues are the result. Various expert committees and sections of the AAP reviewed and approved the list. The AAP Executive Committee granted final approval of the list.
AAP’s disclosure and conflict of interest policy can be found at www.aap.org.
Sources
Lantos P, Lipsett S, Nigrovic L. False positive lyme disease IgM immunoblots in children. J Pediatr. 2016(174):267-269.
Lipsett S, Nigrovic L. Diagnosis of Lyme disease in the pediatric acute care setting. Curr Opin Pediatr. 2016;28(3):287-293.
Markowicz M, Kivaranovic D, Stanek G. Testing patients with non-specific symptoms for antibodies against borrelia burgdorferi sensulato does not provide useful clinical information about their aetiology. Clin Microbiol Infect. 2015;21(1098):1103.
Moore A, Nelson C, Molins C, Mead P, Schriefer M. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United States. Emerg Infect Dis. 2016(22):7.
Sigal L. Musculoskeletal features of Lyme disease: understanding the pathogenesis of clinical findings helps make appropriate therapeutic choices. J Clin Rheumatol. 2011;17(5):256-265
