• Careful monitoring is required with NSAIDs and sulphasalazine.
• Systemic corticosteroids are not indicated.
• Immunosuppressants (low dose weekly methotrexate) may be needed for severe intractable problems with psoriasis and reactive arthritis.
• These conditions should be managed in collaboration with a consultant.
• Although phenylbutazone is the most effective NSAID, its side effects (esp. aplastic anaemia) are a major problem.
Lyme disease (known as Lyme borreliosis) was first described in 1975 and named after the town of Lyme in Connecticut. It has spread to almost all the states of the United States and is appearing in Europe and Asia at an increasing rate. Very infective, it is caused by a spirochete, Borrelia burgdorferi, and transmitted by Ixodes ticks, in particular the deer tick.
Diagnostic serology should be considered for patients with a history of tick bites, typical rash (a doughnut-shaped red rash about 6 cm in diameter) at the bite site, heart disorders (especially arrhythmias), unusual joint arthralgia or central nervous system disease. CNS disease includes muscle weakness of the limbs, muscular pain or evidence of meningitis. In children Lyme disease can be mistaken for juvenile chronic arthritis.
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