Clinical features and outcomes of pediatric Lyme arthritis in Europe: a large Swiss cohort study

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ID: 323034
2026
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Abstract
Abstract Background Lyme arthritis (LA) in children typically manifests as monoarthritis of a large joint. Although the prognosis is generally good, persistent arthritis occurs in 10%–23% of patients despite antibiotic treatment. Most described pediatric LA cohorts are from the U.S., with limited European data available. This study aimed to describe clinical features and outcomes of pediatric LA in Europe using a large Swiss cohort. Methods Children diagnosed with LA at the University Children’s Hospital Zurich, Switzerland between January 1, 2006, and December 31, 2020 were included. Data on clinical disease presentation, laboratory findings, and treatment courses were compared between outcome groups using descriptive statistics and multivariable logistic regression models. Results A total of 107 LA patients were included. Persistent arthritis, defined as symptoms lasting ≥2 months after antibiotics, occurred in 26 patients (24.3%; 95% confidence interval, 16.8%–33.7%). Characteristics associated with persistent arthritis included older age, symptoms >14 days before presentation, delayed LA-specific antibiotic treatment >30 days, absence of empirical antibiotics, and lower blood monocyte counts. Among patients with persistent arthritis, 10 (38.5%) recovered (9 after intra-articular corticosteroid injections), whereas 16 (61.5%) were eventually diagnosed with juvenile idiopathic arthritis (JIA). Conclusions This study provides a comprehensive characterization of pediatric LA in the largest European cohort to date, complementing existing data from the U.S. Early clinical and laboratory features did not reliably differentiate children who achieved resolution from those who developed persistent arthritis. The finding that a substantial proportion of children with persistent arthritis were later diagnosed with JIA highlights the urgent need to identify predictors of disease persistence and to optimize management strategies.
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Authors Beat M Greiter, Semjon Sidorov, Elvira Cannizzaro, Michelle Seiler, Ester Osuna, Franca Baggi Menozzi, Stefanie von Felten, Adrian Egli, Christoph Berger, Patrick M. Meyer Sauteur
Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag458
URL
https://doi.org/10.1093/ofid/ofag458
Keywords Keywords not found

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