Lyme arthritis resolves with appropriate antimicrobial treatment in a majority of patients,
but 10-20% of patients develop antibiotic-refractory Lyme arthritis with prolonged arthritis
symptoms and treatment courses. Excessive up-regulation of the inflammatory process has been
shown in patients with antibiotic-refractory Lyme arthritis. The over-expressed
pro-inflammatory cell mediators are downstream of NSAID inhibition, which would suggest
initial inflammatory inhibition may be beneficial in these patients. While NSAIDs are known
to reduce pro-inflammatory cell mediators early in the course of inflammation, research has
shown that there are other cytokines that play a role in the healing after inflammation that
are also inhibited by NSAIDs, and that NSAID use can delay healing.
It is not known if scheduled NSAID therapy will reduce, increase, or have no effect on the
occurrence of refractory Lyme arthritis cases. The hypothesis of the study is that
prescribing scheduled NSAIDs at the time of diagnosis of Lyme arthritis can prevent the
development of the excessive inflammatory phase and decrease the number of patients with
antibiotic-refractory Lyme arthritis, or at least decrease the duration of persistent Lyme
arthritis symptoms.
The pilot study design randomizes patients to scheduled NSAIDs, scheduled acetaminophen, or
scheduled NSAIDs x 1 week than acetaminophen. Primary outcomes are duration of arthritis
symptoms, number of refractory cases, side effects and compliance.