Shared by permission Dalhousie Faculty of Medicine https://medicine.dal.ca/news/2026/10/20/why_some_children_develop_persi…
Twenty years ago, when Dr. Elizabeth Stringer started practicing in Halifax, she saw one or two patients a year present with Lyme arthritis, a painful joint inflammation that can develop months after a Lyme disease infection.
Today, the paediatric rheumatologist is one of a team of four who sees so many cases that the IWK has a dedicated Lyme arthritis clinic, drawing referrals from across the Maritimes and serving as a resource for physicians nationwide.
That change reflects the rapid rise of Lyme disease in Canada. According to government data, in 2024, the country reported 5,809 cases of Lyme disease, the highest annual total on record. Roughly 40 per cent—2,350—of those cases were reported in Nova Scotia.
As Lyme disease has become increasingly common, Nova Scotia has emerged as an unexpected centre of expertise in one of its most common childhood manifestations. At Dalhousie University and IWK Health, Dr. Stringer is leading research aimed at understanding why some children develop persistent symptoms of Lyme arthritis and how those insights could improve care for patients across Canada.
Searching for answers
Lyme arthritis occurs when the bacteria that causes Lyme disease settles in the joints, most often the knee, triggering inflammation and swelling. Most children recover after a course of antibiotics, though some require additional treatment. Even after two courses of antibiotics, about one in six children continue to experience symptoms, a condition known as post-infectious Lyme arthritis.
"The good news is that, with the combination of treatments we can offer, most of our patients do have resolution of their arthritis," says Dr. Stringer. "I have had some patients with lingering symptoms, but overall, most make a full recovery."
While physicians have become increasingly adept at diagnosing and treating Lyme arthritis, many questions remain unanswered.
One of the most pressing focuses on the small group of patients whose arthritis persists after antibiotic treatment. Researchers still do not fully understand why some children recover quickly while others continue to experience inflammation after the infection is believed to have been cleared.
Dr. Stringer and co-investigator Dr. Beata Derfalvi, along with other collaborators, are following children with Lyme arthritis over time and studying how their immune systems respond to infection. By examining blood samples and, when possible, joint fluid, the team hopes to identify biological signals that distinguish children whose arthritis resolves from those who develop persistent symptoms.
"We want to understand whether the immune systems of patients with persistent arthritis after antibiotics behave differently from those of children whose arthritis resolves," says Dr. Stringer. “We believe this could help to provide insight on how best to treat these children."
The work is among the first of its kind in children and is poised to make a big impact.
An unexpected diagnosis
For many families, a Lyme arthritis diagnosis comes as a surprise. Most children seen in Dr. Stringer's clinic never developed the telltale rash commonly associated with Lyme disease, and many families never knew a tick bite had occurred.
When Vale Dobbelsteyn began complaining of a sore neck and hips, her parents, Julia and Matt, figured she must have slept funny or was experiencing growing pains. When she awoke two days later with an extremely swollen knee and had difficulty walking, they went directly to the Emergency Department at the IWK where she was quickly diagnosed with Lyme disease.
"We had no idea Vale had been bitten by a tick," recalls Julia. "We had never found a tick on her, and she never had the bull’s-eye rash we typically associate with Lyme disease, so the diagnosis was very unexpected."
Vale was given a 28-day course of antibiotics and improved remarkably quickly, with swelling significantly improved within days. The harder part for her parents was the feeling of uncertainty—had they missed something, and would she have lasting effects?
Dr. Stringer quickly dispelled those fears.
"She explained it was very unlikely Vale would experience long-term effects and helped us understand that a tick bite or bull’s-eye rash isn't always noticed," says Julia. "She also reassured us that we shouldn’t stop doing the things we enjoy because of this experience."
Despite the diagnosis, the family's relationship with the outdoors has not changed.
"We still want Vale to go to camp, play sports, explore outside, and do all of the things she loves," Julia says. "We just approach those activities with more awareness, using tick spray, dressing appropriately, doing regular tick checks, and teaching our children to be aware of their own bodies. For our family, it's about being prepared rather than being afraid."
Vale is now thriving and has fully resumed all the activities she loves, including dancing, soccer, running, and golf.
Beyond the clinic
Working closely with children and families has shaped another aspect of Dr. Stringer's research. Her team has learned that many families struggle to find information specific to paediatric Lyme arthritis and can encounter confusing or alarming messages online.
"There is a lot of fear associated with a Lyme disease diagnosis, and families receive a lot of comfort and reassurance from talking this through with us," she says.
In response, Dr. Stringer is working with patient partners and communication specialists to develop educational resources that will help families better understand the condition and know what to expect.
Awareness without fear
As Lyme disease continues to spread, Dr. Stringer and her colleagues at the Lyme arthritis clinic remain the centre of expertise in Canada, caring for a growing number of children and families navigating Lyme arthritis. While important questions remain about why some children develop persistent symptoms and how the disease can be diagnosed more effectively, she is optimistic about the progress being made.
"There is a real tension for families," she says. "We want children to play outside, explore and enjoy nature, but there are now more things to be aware of. The goal isn't to create fear. It's to help families recognize Lyme disease when it occurs, know what to watch for, and feel confident that effective treatment is available."