Serologic Testing For Lyme Disease
The mainstay in diagnosing Lyme arthritis is serologic testing. In the USA, the CDC currently recommends a two-test approach in which samples are first tested for antibodies to B. burgdorferi by enzyme-linked immunosorbent assay and those with equivocal or positive results are subsequently tested by Western blotting , with findings interpreted according to the CDC criteria.26 In contrast with early infection, when some patients may be seronegative, all patients with Lyme arthritis, a late disease manifestation, have positive serologic results for IgG antibodies to B. burgdorferi, with expansion of the response to many spirochetal proteins.27 When serum samples were tested with microarrays of more than 1200 spirochetal proteins, 120 proteins, primarily outer-membrane lipoproteins, were found to be immunogenic, and patients with Lyme arthritis had IgG reactivity to as many as 89 proteins.28 Serologic testing should be performed only in serum, as serologic tests in synovial fluid are not accurate.29
What If A Tick Bites My Dog
The more ticks in your region, the likelier it is that your furry pal will bring them home.
Your dog is much more likely to be bitten by a tick than you are. And where Lyme disease is common, up to 25% of dogs have had it at some point.
About 10% of dogs with Lyme disease will get sick. 7-21 days after a tick bite, your dog might seem like theyâre walking on eggshells. They also might have a fever and enlarged lymph nodes. Plus, they might seem tired. Dogs also get antibiotics for Lyme.
What if my dog brings ticks into my home?
Use a tick control product on your pet to prevent Lyme disease. Also, have your dog vaccinated against Lyme.
Check your dogâs whole body each day for bumps. If you notice a swollen area, see if thereâs a tick there. If you find a tick, wear gloves while you use tweezers to separate it from your dog. Then, put it in soapy water or alcohol, or flush it down the toilet.
Use alcohol to clean the spot on your dog where the tick was attached. Keep an eye on that spot, and also on your dog to make sure theyâre behaving normally. If you notice any changes, check with your vet.
Show Sources
John Aucott, MD, assistant professor of medicine, Johns Hopkins University School of Medicine director, Johns Hopkins Lyme Disease Clinical Research Center.
CDC.
Morbidity and Mortality Weekly Report: âVital Signs: Trends in Reported Vectorborne Disease Cases — United States and Territories, 2004-2016.â
American College of Rheumatology.
Treating Pain Causes By Lyme Disease
When Lyme disease is the cause of pain and arthritis, the primary goal is to remove the bacteria that started a cascade of reactions that contributed to the pain. Just as importantly, the fire of inflammation that has been lit needs to be treated. This inflammation is present with active infections, but can also persist after the infections are successfully treated.
Diet
The foundation for reducing systemic inflammation in the body is to avoid foods that are inflammatory. The foods that most commonly create inflammation are gluten, cow dairy, and sugar. If food allergy testing has been performed, the reactive foods should also be avoided. People with other conditions such as SIBO or MCAS may also need to follow a specific diet. Any food that creates inflammation adds to the level of inflammation already being produced by infections.
Herbal Treatment for Pain
The herb turmeric is one of the most effective treatments for reducing the pro-inflammatory cytokines produced by the immune system in response to tick-borne infections. This reduction in inflammation leads to a reduction in muscle and joint pain, and joint swelling.
Low-dose immunotherapy is a promising therapy that works to improve the immune response in Lyme disease
LDI uses very dilute doses of bacterial antigens to help down-regulate the inflammation produced by bacteria. This treatment has provided remarkable benefits for many people who suffer from pain and neuropathy from Lyme disease and associated infections.
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Is It Lyme Arthritis Or Jia
A Lyme arthritis diagnosis requires a two-step testing approach. False positives are complex and common.
The authors of a review article on the differentiating factors of Lyme arthritis in children recommend that patients suspected of having juvenile idiopathic arthritis in endemic regions for Lyme disease, may have Lyme arthritis and should be screened for Lyme disease.
Two-tier testing is advisable when a patients history suggests a possibility of potential tick bite, writes Elübieta Smolewska this month in the journal Pediatric Rheumatology. The development of consistent worldwide guidelines would simplify the diagnostic process in everyday pediatric practice.
In the absence of such guidelines, Dr. Smolewska and colleagues reviewed the scientific evidence for Lyme arthritis in children.
Clinical features
In the United States, Borrelia burgdorferi sensu stricto is the main cause of Lyme arthritis, while in Europe, two other genospecies of Borrelia burgdorferi have been implicated in Lyme disease: B. garinii and B. afzelii. The two are different in that an infection of the latter occurs within a short period of time from a tick bite, as opposed to a Borrelia burgdorferi sensu stricto infection which can manifest months later any month of the year, not only during summer months.
Diagnostics
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How Does Lyme Disease Cause Pain
The presence of Lyme bacteria triggers a physiological cascade that leads to pain and inflammation.
First, the bacteria travel to joints and connective tissue where they cause direct damage to that tissue. Then the immune system releases cytokines in response to the infection, which in turn creates inflammation. The bacteria can also trigger an autoimmune reaction where the antibodies that are made in response to the bacteria begin to attack the bodyâs tissue.
This autoimmune concept is known as molecular mimicry and can lead to conditions such as rheumatoid arthritis and lupus. Ultimately the goal is to find and treat the cause of the symptoms or diagnosis.
In late-stage Lyme disease, it can be challenging to determine if the infection is still causing symptoms or if the bacterial load has decreased, but the immune response persists creating inflammation. This is a central debate in chronic Lyme disease, and some have termed the latter symptoms Post-treatment Lyme Disease . My approach is to treat both the infection and the overactive immune response.
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Detection Of The Rf Associated Cris On Anti
One half of 96 well Immulon 1 immunoassay plates were coated with 100 l of a 10 g/ml suspension of sonicated B burgdorferi in carbonate buffer by incubation overnight at 4°C, blocked and incubated with sera diluted 1/500 in PBS. Mouse monoclonal anti-CRI antibodies G6 and G8 diluted 1/32000 in PBS were added and bound antibodies revealed with biotinylated rabbit antimouse Ig and streptavidin-HRP. Background binding to the uncoated control wells was subtracted and results expressed as mean OD values.
Expert Q& a: Is There A Link Between Ra And Tick Bites
Learn what an expert says about the connection between rheumatoid arthritis and tick bites.
Question: Is it possible to get RA from a tick-borne illness?
Answer: No, it is not possible to get RA from a tick-borne illness. The only form of arthritis associated with tick bites in this country is the arthritis that occurs with Lyme disease. Lyme disease is caused by a bacterium spread by the deer tick. It is most commonly seen in the northeastern and midwestern U.S. For the majority of people who contract it, the initial symptom is a bulls-eye-shaped rash that forms around the bite site, often followed by symptoms such as headaches, fatigue and joint pain. Unlike RA, the arthritis that occurs with Lyme disease generally affects individual joints not pairs of joints, such as both knees or both wrists. Knees are most commonly affected in Lyme disease, while the joints of the hands a common site of RA involvement are not. If you live in or have visited an area where Lyme disease is prevalent and noticed the development of joint symptoms after a rash, Lyme disease is certainly a possibility, especially if outdoor activities might have brought you into contact with ticks. It is important to share this information with your doctor, who can determine the cause and best treatment.
John Reveille, MD
Director, Division of Rheumatology and Clinical Immunogenetics
University of Texas Health Science Center at Houston
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How Is Lyme Arthritis Diagnosed
When Lyme disease is suspected as the cause of your childs arthritis, its important to be diagnosed by a pediatric rheumatologist who can distinguish Lyme arthritis from juvenile arthritis. Your physician will conduct a full medical exam and may ask questions about where and when your child may have been exposed to ticks. To diagnose Lyme disease, your physician will order blood tests.
There are two blood tests to diagnose Lyme disease:
- Enzyme-linked immunosorbent assay test. The test detects antibodies to B. burgdorferi. False-positive results are not uncommon, so it is used in conjunction with the Western blot test if results are positive.
- Western blot test. If the ELISA test is positive, this test can help confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.
Sorting Out Your Symptoms Seeking A Diagnosis
Rheumatoid arthritis and lupus also known as systemic lupus erythematosus are both autoimmune diseases that can affect many parts of the body. Lyme disease is an infectious disease with some similar symptoms, caused by tick-borne bacteria.
Rheumatoid arthritis, lupus and Lyme disease can all cause severe, disabling joint pain, and the three diseases are frequently mistaken for each other during diagnosis.
Other symptoms that may indicate one or more of these diseases include skin rashes, kidney disease, fever, headaches, fatigue and depression. There are a number of tests that can be done to determine whether you suffer from rheumatoid arthritis, lupus or Lyme disease.
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How Is Lyme Disease Treated
With early-stage Lyme disease, youâll take antibiotics for about 10 days to 3 weeks. The most common ones are amoxicillin, cefuroxime, and doxycycline. The antibiotics will almost always cure your infection. If they donât, you might get other antibiotics either by mouth or as a shot.
If you donât treat your Lyme infection, you might need oral antibiotics for symptoms like weakened face muscles and irregular heartbeat. You may need antibiotics if you have meningitis, inflammation in your brain and spinal cord, or more severe heart problems.
If your Lyme is late stage, the doctor might give you antibiotics either by mouth or as a shot. If it causes arthritis, youâll get arthritis treatment.
Thereâs no therapy for post-treatment Lyme disease syndrome.
Diet & Targeted Exercise Can Help Lyme
If you have Lyme disease, discuss a protocol for killing the bacteria with your doctor. Of course, this is imperative for eliminating symptoms.
That said, most Lyme protocols take time, and there is much more you can do during treatment to mitigate symptoms of pain.
For instance, Dr. Farshchians clinic advises people with Lyme arthritis to decrease any environmental factors that may contribute to inflammation, such as mold exposure or mast cell activation . Addressing common comorbidities often makes a significant improvement in symptoms, she says. In addition, her clinic aims to help patients reduce inflammation organically through diet, lifestyle, anti-inflammatory herbal supplements, medications, light therapy, Epsom-salt baths, and exercise.
In my experience and that of my clients, all these approaches can be helpful. Below are a few of my favorite strategies.
1. Rolling with a foam roller
One thing you can easily do at home is to roll tight tissue in your body with a foam roller. This helps to lengthen and release tension in your fascia, or connective tissue.
Rollers are inexpensive and available online. Just play with gently rolling the muscles surrounding painful joints, or really any sore muscles at all, with the roller. If you need ideas for how to experiment with this, this video demonstrates my favorite ways to roll.
2. Gentle strengthening
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Lyme Diseaseassociated Autoantibody Responses
Of the 30 patients with systemic autoimmune joint disorders, 27 had sufficient sera available to test for 3 Lyme diseaseâassociated autoantibodies . Of these 27 patients, 6 had positive results for 1 or more of the Lyme diseaseâassociated autoantibodies, and 4 were positive for 2 autoantibodies . Of the 6 patients, 2 had RA, 3 had PsA, and 1 had SpA. In comparison, 19 of the 43 patients with LA had 1 or more of the Lyme diseaseâassociated autoantibodies . Moreover, the levels of ECGF antibodies, the most specific of the Lyme diseaseâassociated autoantibodies , were significantly increased in both the responsive and refractory LA groups compared with the systemic autoimmune disease group . The levels of MMP-10 and Apo-B 100 autoantibodies were significantly greater in the refractory versus the responsive LA group , and MMP-10 levels tended to be greater than those in the systemic autoimmune joint disorder group . In contrast, autoantibody positivity in the LA group and in the postâLyme disease systemic autoimmune disease group were significantly greater than in healthy controls, or in RA or PsA/SpA patients who lacked a history of Lyme disease . Of the 3 LA patients who experienced arthritis that spread to previously uninvolved joints in the postinfectious period, 2 had positive results on tests for MMP-10 autoantibodies, and 1 had reactivity with all 3 autoantibodies.
Figure 4
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What Are The Symptoms Of Lyme Arthritis
Lyme arthritis usually occurs during a later stage of Lyme disease that has not been treated. For many children, arthritis is the first symptom of Lyme disease they experience, and most do not remember being bitten by a tick.
Symptoms of Lyme arthritis include:
- Joint pain, usually in the knees
- Joint swelling, usually in the knees
- Limping or inability to put weight on a limb
Early symptoms of Lyme disease may include:
- Enlarging, warm rash at the site of the bite that can last days to weeks, often with a partial central clearing so that it looks like a bulls eye
If left untreated, later stage symptoms of Lyme disease can include:
- Rash on other parts of the body
- Severe headache and neck stiffness
- Pain and swelling in the large joints
- Heart palpitations
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What Are The Symptoms Of Lyme Disease
Symptoms can start anywhere from 3 to 30 days after the bite. They may look different depending on the stage of your infection. In some cases, you wonât notice any symptoms until months after the bite.
Early symptoms include:
All of those symptoms are also common in the flu. In most Lyme infections, one of the first symptoms youâll notice is a rash.
Without treatment, symptoms can get worse. They might include:
- Severe headache or neck stiffness
- Rashes on other areas of your body
- Arthritis with joint pain and swelling, particularly in your knees
- âDroopingâ on one or both sides of your face
- Inflammation in your brain and spinal cord
- Shooting pains, numbness, or tingling in your hands or feet
What does the rash look like?
Some Lyme rashes look like a bull’s-eye with circles around the middle. But most are round, red, and at least 2 inches across.
The rash slowly gets bigger over several days. It can grow to about 12 inches across. It may feel warm to the touch, but itâs usually not itchy or painful. It can show up on any part of your body.
How small are ticks?
Ticks come in three sizes, depending on their life stage. They can be the size of a grain of sand, a poppy seed, or an apple seed.
Lyme Disease And The Autoimmune Connection
Each year, more than 30,000 new cases of Lyme disease are reported to the Centers for Disease Control and Prevention , although the true prevalence is likely to be closer to 476,000 and its on the rise. While not classified as an autoimmune disease, research indicates that Lyme disease may trigger an autoimmune response and/or its symptoms may mimic an autoimmune disease.
Lyme disease is caused by the bacteria Borrelia burgdorferi and Borrelia mayonii, transmitted through the bite of an infected blacklegged tick. Left untreated, Lyme disease can cause chronic joint inflammation , typically in the knee but also occurring in the shoulders, ankles, elbows, and wrists neurological symptoms, such as facial palsy and neuropathy cognitive defects, such as impaired memory heart palpitations and irregular heartbeat and nerve pain. Lyme disease usually responds well to antibiotics, and prompt treatment can help avoid these escalating effects on the body.
As Meghan described, the first signs of Lyme disease are often flu-like symptoms, such as fever, chills, headache, fatigue, muscle, joint pain, and swollen lymph nodes. In 70-80% of infected people, a rash in the pattern of a target or bulls-eye will appear. This rash, known as erythema migrans, can spread over a large part of the body over several days. While this rash is one of the hallmarks of Lyme disease, not everyone who has been infected will develop it.
Post-Treatment Lyme Disease Syndrome and Autoimmune Diseases
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Systemic Arthritis After Lyme Disease
When a patient presents with a history of Lyme disease and joint pain, refractory Lyme arthritis seems reasonable, but then, this study warns of systemic arthritis after a Lyme disease infection.
When a patient presents with a history of Lyme disease and joint pain, it might be reasonable to assume that they’re dealing with refractory Lyme arthritis. And in some cases, that’s true. However, a new study warns that systemic arthritis can also arise after Lyme disease, and that the Lyme history can confound the real diagnosis of an autoimmune disorder like rheumatoid arthritis or psoriatic arthritis.
“Making the distinction isn’t always easy,” said Sheila Arvikar, M.D., a rheumatologist at Massachusetts General Hospital.
Dr. Arvikar and her colleagues conducted a retrospective study of patients referred to the hospital’s Lyme arthritis clinic between 2003 and 2015 and found 30 patients who were found to have a systemic autoimmune joint disease rather than Lyme arthritis. Compared to patients who did have Lyme arthritis, this group was older, more likely to have shown early symptoms of Lyme disease and more likely to have a family history of autoimmune disorders.
Lyme and arthritis
“We think there may be a connection,” Dr. Arvikar said.
Lyme arthritis versus systemic disease
Making the diagnosis
“It’s a possibility that need to consider in people who develop arthritis after Lyme infection,” she said.