Choosing Wisely:

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

Rationale and Comments: The musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia with early disseminated Lyme and/or intermittent or persistent episodes of arthritis in one or a few large joints, with predilection for the knee, in late disease. Lyme testing in the absence of these features and without appropriate exposure from living in or traveling to a Lyme endemic area 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 Academy of Pediatrics – Section on Rheumatology
  • Sources:
  • Expert consensus
  • Disciplines:
  • Infectious disease
  • References: • Lantos P, Lipsett S, Nigrovic L. False positive Lyme disease IgM immunoblots in children. J Pediatr. 2016(174):267-269.
    • Lipsett S, Nigrovic L. Diagnosis of Lyme disease in the pediatric acute care setting. Curr Opin Pediatr. 2016;28(3):287-293.
    • Markowicz M, Kivaranovic D, Stanek G. Testing patients with non-specific symptoms for antibodies against borrelia burgdorferi sensulato does not provide useful clinical information about their aetiology. Clin Microbiol Infect. 2015;21(1098):1103.
    • Moore A, Nelson C, Molins C, Mead P, Schriefer M. Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of Lyme disease, United States. Emerg Infect Dis. 2016(22):7.
    • Sigal L. Musculoskeletal features of Lyme disease: understanding the pathogenesis of clinical findings helps make appropriate therapeutic choices. J Clin Rheumatol. 2011;17(5):256-265.

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