American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be the treatment for oligoarticular arthritis caused by Lyme disease?

1. Oral azithromycin

2. Oral doxycycline or amoxicillin

3. Intravenous ciprofloxacin

4. Intravenous doxycycline

The correct answer is: Oral doxycycline or amoxicillin

In cases of oligoarticular arthritis resulting from Lyme disease, the recommended treatment is oral doxycycline or amoxicillin. This approach is effective because these antibiotics are specifically indicated for treating Lyme disease, particularly when it presents as arthritis. Doxycycline is preferred due to its efficacy against the Borrelia burgdorferi bacteria, which causes Lyme disease, and its ability to penetrate well into joint tissues. Amoxicillin is a suitable alternative, especially for children or pregnant women who may not be able to take doxycycline. The option of using oral antibiotics is particularly beneficial for oligoarticular involvement, as early treatment can lead to significant improvement and resolution of symptoms. While other treatments may be employed in different contexts or for various infections, they are not indicated for this specific case of Lyme-related arthritis. For example, options like intravenous treatments are usually reserved for more severe manifestations of Lyme disease or when oral therapy fails.