Choosing Wisely:

Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings.

Rationale and Comments: The musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia or intermittent or persistent episodes of arthritis in one or a few large joints at a time, especially the knee. Lyme testing in the absence of these features 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.
Sponsoring Organizations:
  • American College of Rheumatology—Pediatric Rheumatology
  • Sources:
  • Infectious Diseases Society of America guidelines
  • Centers for Disease Control and Prevention
  • Disciplines:
  • Rheumatologic
  • Infectious disease
  • References: • Lyme Disease Diagnosis and Treatment. [Internet]. Atlanta (GA). Centers for Disease Control and Prevention. [Updated 2011 Nov 15; cited 2012 Sep 6]. Available from: www.cdc.gov/lyme/diagnosistreatment/index.html.
    • American College of Physicians. Guidelines for laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med. 1997;127(12):1106-8. Hu LT. Lyme disease. Ann Intern Med. 2012;157(3):ITC2-1.
    • Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-134.

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