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Investigators from multiple institutions conducted a case-control study to identify clinical and treatment features associated with antibiotic-refractory Lyme arthritis (ARLA) in children. Study participants were identified by reviewing medical records of patients <18 years old with a diagnosis of Lyme arthritis (LA) seen at 1 of 4 pediatric rheumatology clinics in a Lyme-endemic region between 2000 and 2013. Only children with a clinical diagnosis confirmed by Western blot testing and documented arthritis were eligible. Cases were patients with active LA despite ≥8 weeks of oral antibiotics (amoxicillin, doxycycline, or cefuroxime) or ≥2 weeks of IV antibiotics (ceftriaxone or cefotaxime). Controls were children with documented resolution of LA within 3 months of starting antibiotics; LA was considered resolved when there was no joint pain or stiffness and minimal or no effusion on …
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