Chronic Lyme Arthritis: A Mystery Solved
- By John Ross, MD, FIDSA, Contributing Editor
In 1975, researchers from Yale investigated an epidemic of 51 patients with arthritis who lived near the woodsy town of Lyme, Connecticut. The most common symptom was recurrent attacks of knee swelling. A few had pain in other joints, such as the wrist or ankle. Many had fever, fatigue, and headache. Some remembered a round skin rash before the onset of knee swelling.
We now know that Lyme disease is an infection acquired from tick bites, caused by a spiral bacterium named Borrelia burgdorferi. After a tick bite, Borrelia bacteria wriggle through the skin away from the bite site. This leads to a circular red rash, known as erythema migrans. In its more advanced stages, erythema migrans may take on a bullseye appearance. Many people are unaware of the rash, as it is usually painless, and ticks may bite in less visible locations, such as a buttock or shoulder blade.
Lyme disease is diagnosed with blood tests that detect antibodies to B. burgdorferi. Two-step testing is traditionally performed. A rapid enzyme immunoassay is performed first. If this is positive, a more time-consuming Western blot test is sent for confirmation. The FDA recently approved two rapid tests for Lyme disease that are performed simultaneously, reducing the turnaround time.
What Do You Do If There’s A Tick Under Your Skin
Use a pair of fine-tipped tweezers to remove it as soon as possible. Pull upward with steady pressure. If parts of the tick are still in your skin, try to get those with the tweezers, too. After everything is out, clean the bite area with rubbing alcohol or soap and water.
You probably wonât get infected if you remove the tick within 36 to 48 hours.
How do you throw away a tick?
Put it in soapy water or alcohol, stick it to a piece of tape, or flush it down the toilet.
Prevention Of Lyme Arthritis
Preventive measures to avoid or minimize tick bites are important and may include landscaping measures, removal of deer from specific areas, wearing appropriate clothing such as pants tucked into socks, and tick repellants. In areas where ticks are common, its important to check your child frequently and remove any ticks. Ticks may remain on your childs skin for hours before attaching themselves, so checking for ticks after coming inside may help remove them before they attach.
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Imaging For Lyme Arthritis
X-rays are a helpful diagnostic tool to identify the cause of arthritis and pain. Joint space narrowing is the hallmark finding on X-ray in osteoarthritis, and not seen in other causes of joint pain. Lyme disease rarely causes changes of the bones on X-ray.
Soft tissue swelling will be seen with Lyme disease and trauma, not in other conditions.
An MRI of a joint is useful at differentiating Lyme arthritis from septic arthritis or structural damage. In Lyme disease, an MRI will demonstrate joint effusion, synovitis, and muscle edema .
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Thank you for helping to raise awareness about Lyme. A lot of people are still not well informed about how serious it can be. If left untreated it can be terrible. I found this website to be a good resource if you have questions about Lyme: http://www.lyme-disease-research-database.com
Thanks for bringing up the topic of Lyme disease. I’ve only just found this forum and the wealth of information looks really great.
I’ve had Lyme disease for 25 years but it took 20 years to find out. I’m now taking antibiotics but it was hard to get a doctor to understand that the infection was still there after all those years. My face had a kind of bell’s palsy for 8 months. I never got the Bulls Eye rash at the beginning, even though there were 12 ticks on my shins. But when I began treatment the rash came out as several small red ring-shapes on my legs. I am slightly better – the vertigo has gone, but the longer the time before treatment, the longer it takes to get better. I might have got permanent damage to my heart and nerves but I am still optimistic that I will slowly get my life back.
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Synovial Fluid Analysis Imaging And Other Tests
On presentation, joint aspiration is usually done for diagnostic purposes to rule out the presence of other arthritides such as crystalline arthropathy or staphylococcal septic arthritis. Joint fluid white cell counts are usually inflammatory in the range , but cell counts as low as 500 or as high as 100,000 cells/mm3 have been reported. Although tests for rheumatoid factor or antinuclear antibodies typically yield negative results, antinuclear antibodies in low titer may be detected. Peripheral white blood cell counts are usually within the normal range, but inflammatory markers, such as ESR and CRP, may be elevated. Imaging studies are not required for diagnosis or are not typically performed. The major reason for imaging studies in Lyme arthritis is when there are concerns for alternative diagnoses.
In patients with Lyme arthritis, plain films, MRI scanning or ultrasound typically show non-specific joint effusions, while MRI studies utilizing contrast dye, may display synovial thickening or enhancement. In adult patients, imaging studies may show co-incidental degenerative changes or chronic mechanical injuries, but these abnormalities would not be expected to cause significant synovitis or inflammation. Lyme arthritis is not rapidly erosive, but with longer arthritis durations, joint damage can be seen on radiographic studies. Finally, MRI scanning may be useful in the planning of synovectomies by determining the extent of synovitis within the joint.
What Is Lyme Arthritis
Lyme arthritis occurs when Lyme disease bacteria enter joint tissue and cause inflammation. If left untreated, permanent damage to the joint can occur. Lyme arthritis accounts for approximately one out of every four Lyme disease cases reported to CDC. Because of reporting practices, this statistic may overstate the frequency of arthritis among patients seen in routine clinical practice.
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How Does Arthritis Present In Lyme Disease
Intermittent inflammatory arthritis often begins as a migratory polyarticular process involving bursae, tendons, and joints, which evolves over 1-2 days into a monoarticular process involving the knee, ankle, and wrist, in decreasing frequency. When asked about symptoms after they have resolved, patients with Lyme disease are less likely to remember those symptoms that occurred before the monoarthritis. Polyarticular episodes may also occur.
In two thirds of patients, the first episode occurs within 6 months of the erythema migrans lesion. Untreated, the episodes last approximately 1 week. Two thirds of patients have three recurrences approximately 2.5 months apart. The recurrences are more likely to involve more than one joint. With time, these episodes become less frequent and severe and involve fewer joints. Even without treatment, the recurrent episodes usually resolve over a 10-year period.
Some patients may present with intermittent joint pain without inflammatory findings. This is more common in Europe, where arthritis was not recognized as a manifestation of Lyme disease until the early reports from the United States.
Feder HM Jr. Lyme disease in children. Infect Dis Clin North Am. 2008 Jun. 22:315-26, vii. .
Centers for Disease Control and Prevention. Lyme Disease: Diagnosis and Testing. CDC. Available at . November 20, 2019 Accessed: March 30, 2021.
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. 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. 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. Serologic testing should be performed only in serum, as serologic tests in synovial fluid are not accurate.
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What Are Signs And Symptoms Of The Third Stage Of Lyme Disease
Late stage Lyme disease can result when treatment is unsuccessful or started too late due to unrecognized symptoms or misdiagnosis. The late disseminated stage occurs months or years after initial infection and can have a major impact on a patients health and quality of life. Late Lyme arthritis is a third stage Lyme disease manifestation that involves fluid accumulation and pain in joints, particularly in the knee joints. Late neurologic disease is a 3rd stage condition that can also be debilitating and difficult to diagnose. Late disseminated Lyme disease symptoms include a variety of symptoms that are often neurologic in origin including: numbness in extremities, mental fogginess and concentration problems, and difficulty following conversations or processing information.
When Should You See A Doctor If You Think You Have Lyme
The rash is a pretty good indication that you may have been bitten. Take a photo of the rash and see your doctor. At this stage, treatment with antibiotics will probably work.
If you don’t have the rash but have symptoms like fatigue, fever, and headache but no respiratory symptoms like a cough, you may want to talk to your doctor.
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What’s The Best Way To Prevent A Tick Bite
Ticks can’t fly or jump. But they live in shrubs and bushes and can grab onto you when you pass by. To avoid getting bitten:
- Wear pants and socks in areas with lots of trees and when you touch fallen leaves.
- Wear a tick repellent on your skin and clothing that has DEET, lemon oil, or eucalyptus.
- For even more protection, use the chemical permethrin on clothing and camping gear.
- Shower within 2 hours after coming inside. Look for ticks on your skin, and wash ticks out of your hair.
- Put your clothing and any exposed gear into a hot dryer to kill whatever pests might be on them.
How do you know if you’ve been bitten?
Since ticks are so small, you’ve got to have pretty good eyes to see them.
If you have a small, red bump on your skin that looks like a mosquito bite, it could be a tick bite. If it goes away in a few days, itâs not a problem. Remember, a tick bite doesnât necessarily mean you have Lyme disease.
If you notice a rash in the shape of a bull’s-eye, you might have a tick bite. Talk to your doctor about treatment.
If you have an allergic reaction to ticks, you’ll notice a bite right away.
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
- Bells palsy
- Severe headache and neck stiffness
- Pain and swelling in the large joints
- Heart palpitations
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What Kind Of Arthritis Is Caused By Lyme Disease
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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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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.
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Managing Lyme Arthritis Pain: Can Herbs Help
Stephen Harrod Buhner is a well-known herbalist and author who specializes in the treatment of Lyme disease and co-infections. His book, Healing Lyme, Natural Healing of Lyme Borreliosis and the Coinfections Chlamydia and Spotted Fever Rickettsioses, is based on extensive research on Lyme disease and was the first book I bought after my Lyme diagnosis.4 It offers an exhaustive description of what occurs during Lyme infection, as well as a detailed herbal protocol that Ive been following for the past 3 years.
Buhner writes that Lyme joint pain is caused by the way Borrelia burgdorferi interacts with joint spaces in the body. According to Buhners book, The most important thing to understand about Lyme disease is that the bacteria have an affinity for collagenous tissue. This is at the root of every symptom they cause… Wherever feed on those tissues is where the symptoms occur.
Joints are largely composed of collagen both cartilage and synovial fluid are collagenous structures. Lyme bacteria break down and eat collagen wherever they lodge. As you can imagine, this leads to inflammation and pain.
Lyme can plant itself into any collagenous tissue in the body meaning it can infect any joint space. It can also choose the myelin sheaths around nerve tissue in the brain or spinal cord, also made of collagen. This results in neurological symptoms, and is another reason Lyme patients symptoms and pain are so different.
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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.
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.