Thursday, May 26, 2022

Do Rheumatologists Treat Lyme Disease

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Symptoms Of Post Treatment Lyme Disease

Long Haul Lyme Disease Risk Found: Even in Early Treated Patients | Johns Hopkins Rheumatology
  • Include severe fatigue, musculoskeletal pain, & cognitive problems
  • Can significantly impact patients health and quality of life
  • Can be debilitating and prolonged

Our research indicates the chronic symptom burden related to PTLD is significant. Although often invisible to others, the negative impact on quality of life and daily functioning is substantial for PTLD sufferers.

The chronic symptom burden related to Lyme disease is considerable, as shown on the left side of the graph above, and statistically significantly greater than the aches and pains of daily living experienced by the control group, on the right.

Signs Of Arthritis After Lyme Disease

Joints are complex structures that connect bones to each other. These structures also make it possible to twist, bend and move your body. Arthritis happens when inflammation affects joint functioning.

The symptoms of arthritis after Lyme disease often come on suddenly and may include:

  • Brief periods of joint pain, swelling and stiffness
  • Pain that occurs in just one joint, typically a large one like your knee
  • Difficulty performing once simple activities, like standing from a seated position or climbing stairs
  • A popping sensation when you use the joint. Find out more about crepitus .

What Are The Most Common Chronic Lyme Disease Symptoms

Early symptoms often resemble the flu or general fatigue, so you may not connect the symptoms with a tick bite. About 70-80% of those infected with the bacteria develop a rash, which begins at the bite, then gradually expands. It may develop a bulls-eye appearance, but it can also look like an ordinary rash.

If the infection is left untreated, it spreads and causes symptoms like joint, muscle, and bone pain. In severe cases, Lyme disease leads to nerve pain, an irregular heartbeat, and brain inflammation. Schedule an appointment with the team at Ramos Rheumatology if you have any Lyme disease symptoms to ensure they catch it at an early stage.

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Diagnosis Of Lyme Disease

If you have symptoms, your doctor orders a two-part process to diagnose Lyme disease. The two parts of the blood test happen at the same time. It’s designed to limit the chances of getting incorrect results. You may not know that a tick bit you. These bugs are about the size of a poppy seed. A history of tick exposure is part of the diagnosis process. So, your doctor may ask where you’ve traveled or whether you’ve been spending lots of time outdoors.

Why This Is Important

Chronic Lyme disease: Symptoms, diagnosis, and treatment

The use and duration of antibiotics for chronic Lyme disease treatment is controversial because there is no biomarker that can determine whether the Lyme bacteria has been eradicated in CLD patients. Patients are often told that either chronic Lyme disease does not exist or that it is incurable. If this were true, we would not expect more well and substantially improved patients to be taking antibiotics. Instead, we might have expected the percentage of people using antibiotics to be roughly the same among the patient subgroups.

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What Is A Rheumatologist

A rheumatologist is a physician or pediatrician who is trained in the area of rheumatology. This enables him or her to better diagnose, treat, and care for patients suffering from a variety of rheumatic diseases.

Rheumatologists have experience in treating many different forms of arthritissuch as RA, osteoarthritis, and psoriatic arthritiswith a specialty focused on musculoskeletal diseases and systemic autoimmune conditions that affect the joints, bones, and muscles.

RA is a complex connective tissue disease, making it difficult to diagnose in its early stages. Additionally, it can easily be confused with other conditions which have similar symptoms, such as lupus and Lyme disease. However, because of their advanced knowledge in this area, rheumatologists are often able to detect early signs of RA and other forms of arthritis that other doctors may not be able to initially identify.

Obtaining a RA diagnosis may require several visits on your part, but once the rheumatologist identifies and analyzes your symptoms, he or she can better determine the exact diagnosis and treatment options most suitable for you, the patient.

What Is Post Treatment Lyme Disease Syndrome

Although most cases of Lyme disease can be cured with a 2- to 4-week course of oral antibiotics, patients can sometimes have symptoms of pain, fatigue, or difficulty thinking that lasts for more than 6 months after they finish treatment. This condition is called Post-Treatment Lyme Disease Syndrome .

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What Is The Best Treatment For Lyme Disease

Lyme disease is treatable and can be cured in most people, but its vital to begin treatment with oral antibiotics as early as possible. Dr. Ramos and Ms. Sokoloski may prescribe doxycycline, amoxicillin, cefuroxime, or another antibiotic to cure the infection.

They may also recommend supportive therapies that help your body fight the infection and heal more quickly, like intravenous nutrition therapy to boost your bodys natural healing ability and high doses of vitamin C.

Lyme disease treatment will be the same even if the disease spreads to other parts of your body. Most of the problems caused by Lyme disease, including arthritis, are cured with comprehensive treatment.

How Is Lyme Arthritis Diagnosed

Lyme Disease Prognosis – Johns Hopkins – (5 of 5)

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.

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What Is A Lyme

A LLMD is a physician whose experience with Lyme disease patients makes them familiar with the vast range of symptoms, co-infections, and complications associated with the disease at various stages. Because of this knowledge and expertise, many patients also find LLMDs more open-minded and understanding of their experiences, especially if theyre having a hard time getting an accurate diagnosis from another physician.

But how do you know if you need to see a LLMD? Below are some common reasons, any or all of which may apply to you.

What Do Rheumatologists Help With

Because they studied in rheumatology specifically, rheumatologists are the physicians best able to diagnose a variety of rheumatic conditions by examining symptoms, performing medical tests, and asking specific questions of their patients.

As part of this process, the rheumatologist must also rule out other conditions which have the same type of joint pain or fatigue as RA. Some that are similar, yet must be treated differently, are lupus, Lyme disease, and relapse polychondritis. Once a diagnosis of RA is confirmed, the rheumatologist recommends ongoing medical treatments and monitors the patient regularly.

For patients with RA, rheumatologists assist with the treatment of its many symptoms, including joint pain, swelling and inflammation, stiffness, and deformities. Ultimately, a rheumatologists role in treating RA is to prevent joint damage or limit it as much as possible through aggressive, targeted treatments. They are also there to help improve the quality of life of their patients.

Due to the complex and chronic nature of RA, rheumatologists must also look for any potential signs of complications that may arise because of the autoimmune condition. This includes monitoring for secondary health conditions which tend to be more common with RA patients, such as Sjogrens syndrome and psoriatic arthritis.

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Transmission Of Lyme Disease

Black-legged ticks are most commonly found in the Northeast, the Pacific Coast and the upper Midwest. While they can attach to any part of the body, people are more likely to be infected if they are bitten in obscured areas, such as the armpits, scalp and groin, where the bites are less likely to be noticed. Since a tick must be attached to its host for 36 to 48 hours in order to transmit Lyme disease, it is best to discover and remove a tick before it becomes engorged with its hosts blood.

A Rheumatologist May Change Your Diagnosis Along The Way

Chronic Lyme Disease Treatment

The diagnosis your primary care doctor has in mind may not be what your rheumatologist determines. Whats more, because there are lots of overlapping diseases and diseases with similar symptoms, your diagnosis may change months or years later if you develop a new symptom.

This probably happens more frequently in rheumatology than in other specialties like endocrinology. Its pretty easy to make a diagnosis of diabetes, but in rheumatology many diseases dont have blood tests that make the diagnosis. A positive blood test for rheumatoid factor doesnt necessarily mean you have RA, and you can have RA with a negative blood test. It can be frustrating but things arent always clear, and they do change over time, says Dr. Fraenkel, who also directs Patient-Centered Population Health Services at Berkshire Health Systems.

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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.

Treating Joint Pain From Lyme Disease

Most people feel better with the help of antibiotics and anti-inflammatory medications. However, as many as one in 10 people continue having symptoms.

When you come to Aurora, you are not out of options. Our orthopedic experts can offer additional treatments to help you get lasting relief.

Additional treatments for arthritis after Lyme disease include:

  • Physical therapy: We strengthen the muscles that support joints and relieve joint pain with the help of special exercises. Our physical therapists also teach you more comfortable ways of performing everyday activities, like getting out of a car. Learn more about orthopedic physical therapy.
  • Steroid injections: Steroids are medications that reduce pain and swelling. We use special imaging technology to guide the needle to just the right spot and then inject the medication into the joint. Find out more about injections for joint pain.
  • Arthroscopy: If other treatments fail to relieve the symptoms, we examine the joint tissue during a short, minimally invasive procedure . Using a thin, flexible surgical instrument , we evaluate the tissue and make repairs right on the spot.

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How Is It Treated

An initial episode of Lyme arthritis should be treated with a 4-week course of oral antibiotics. Patients with persistent joint inflammation and pain after the first course of antibiotics may require a second course . In some cases, joint swelling and pain can persist or recur after two courses of antibiotics. The cause of persistent arthritis is unknown but is thought to be driven by immunologic factors. Additional antibiotics have not been shown to improve these symptoms, and patient referral to a rheumatologist should be considered.

What To Know About Seeing A Doctor And Getting Tested

Understanding the Persistent Symptoms in Lyme Disease | Johns Hopkins Medicine

Whatever kind of doctor you see, they will consider your medical history, your symptoms, and your Lyme disease test results when making a diagnosis. They should perform what is known as a differential diagnosis in order to rule out common misdiagnoses, such as Rheumatoid Arthritis, Chronic Fatigue Syndrome, ALS, MS, etc.

Many doctors rely on the two-tier system recommended by the Centers for Disease Control and Prevention, which consists of the following two blood tests:

  • EIA
  • Western blot test

However, research shows that these tests are severely limited in accuracy and sensitivity. A LLMD may be able to help you get tested with newer and more accurate testing technology.

Lyme disease recovery starts with finding a doctor who has sufficient experience with Lyme as well as access to the right diagnostic testing. To learn more about what tests are available for Lyme disease today, including IGeneXs ImmunoBlot test, check out the blog The Best Test for Lyme Disease.

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What Is Post Treatment Lyme Disease

Post Treatment Lyme Disease represents a research subset of patients who remain significantly ill 6 months or more following standard antibiotic therapy for Lyme disease. PTLD is characterized by a constellation of symptoms that includes severe fatigue, musculoskeletal pain, sleep disturbance, depression, and cognitive problems such as difficulty with short-term memory, speed of thinking, or multi-tasking. In the absence of a direct diagnostic biomarker blood test, PTLD has been difficult to define by physicians, and its existence has been controversial. However, our clinical research shows that meticulous patient evaluation when used alongside appropriate diagnostic testing can reliably identify patients with a history of previously treated Lyme disease who display the typical symptom patterns of PTLD.

What Treatment Approach Did Well Patients And High Responders Use

We asked patients what their treatment approach was and listed four options a) antibiotics, b) alternative treatments, c) both antibiotics and alternative treatments, and d) no treatment at all. High treatment response was most closely associated with the use of antibiotics compared to patients who were using alternative treatments alone or forgoing treatment altogether. Treatment with antibiotics for Lyme disease was far higher among well patients and high responders compared to non-responders .

As you can see in the chart below, many patients who were taking antibiotics were also taking herbal supplements, which can be antimicrobial . So it is possible that there was a synergistic effect between antibiotics and herbal supplements.

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Revision For Currency Schedule

Approximately every 2 years and more frequently, if needed, IDSA, AAN, and ACR will determine the need for revisions to the guideline by an examination of the current literature and the likelihood that any new data will have an impact on the recommendations. If necessary, the entire expert panel will be reconvened to discuss potential changes. Any revision to the guideline will be submitted for review and approval to the appropriate Committees and Boards of IDSA, AAN, and ACR.

Whether A Rheumatologist Has Been Your Partner In Health For Years Or Youre Pondering Seeing One For The First Time Heres Some Things To Know About These Quite Special Specialists

Treating Inflammatory Arthritis Post Lyme Disease ...

Heres the textbook definition of a rheumatologist from the American College of Rheumatology:

A rheumatologist is an internist or pediatrician who received further training in the diagnosis and treatment of musculoskeletal disease and systemic autoimmune conditions commonly referred to as rheumatic diseases. These diseases can affect the joints, muscles, and bones causing pain, swelling, stiffness, and deformity.

After they receive their MD or OD, rheumatologists spend three years training to become an internist or pediatrician, followed by two to three more years in a rheumatology fellowship.

Like all physicians, they are lifelong learners who take continuing medical education to keep up to date in their field especially with the emergence of new and complex treatments such as biologics.

Rheumatologists treat many similar joint diseases as orthopedists, but they dont do surgery. Many common diseases that they treat include rheumatoid arthritis, gout, lupus, osteoarthritis, and chronic back pain, but theres a lot about rheumatology you might not know. Read on to learn more about what rheumatologists do and when it makes sense to see one.

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Do I Need To See An Infectious Disease Specialist To Get Tested For Lyme Disease

No, you do not need to see an infectious disease specialist.

As noted above, any type of physician should be able to order the correct diagnostic tests, interpret your test results, and provide antibiotics to treat Lyme disease. This is especially true the earlier the disease is caught.

In fact, American Lyme Disease Foundation points out that waiting for an appointment with an infectious disease or other type of specialist can actually delay your diagnosis and treatment. If you were bitten by a tick, notice symptoms of Lyme disease, or believe youre at risk for Lyme or another tick-borne disease, its important that you make an appointment with a doctor immediately even if its your primary care physician.

That said, there are plenty of reasons why you may want to consult with, or get a second opinion from, someone with specific experience with Lyme disease. In other words, you may want to make an appointment with a Lyme-literate doctor . Read on to learn more.

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
  • Fever

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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