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.
Synovial Fluid Pcr For B Burgdorferi
Although reported in a few patients,30 it is exceedingly difficult to culture B. burgdorferi from synovial fluid in patients with Lyme arthritis. This is presumably due to the fact that joint fluid, with its many inflammatory mediators, is an extremely hostile environment. In spiked cultures, adding small amounts of joint fluid results in rapid killing of spirochetes.13 In contrast, polymerase chain reaction testing of synovial fluid for B. burgdorferi DNA often yields positive results before antibiotic therapy ,13,31 and usually becomes negative following antibiotic treatment.12 However, spirochetal DNA may persist after spirochetal killing, which limits its use as a test for active infection. Moreover, PCR testing has not been standardized for routine clinical use. Therefore, in most cases, the appropriate clinical picture and a positive serologic result are sufficient for diagnosis of Lyme arthritis, and PCR testing serves as an optional test to further support the diagnosis.
Chronic Lyme Arthritis: A Mystery Solved
- By John Ross, MD, FIDSA, Contributor
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.
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Joint And Muscle Pain With Liver Disease
Classic signs of liver disease include jaundice, or yellowing of the skin, and a swollen abdomen. However, doctors also associate certain joint and muscle issues with liver disease.
A common cause of joint pain in people with liver disease is arthritis, which is inflammation of the joints. Arthritis can cause joint swelling, stiffness, and pain.
In late stage liver disease, a person may develop cirrhosis. This is where scar tissue replaces healthy tissue, preventing the liver from functioning correctly. The incidence of , which occurs due to an infection, is up to two times greater in those with cirrhosis.
This article looks at joint and muscle pain with liver disease and its causes.
Yes, joint and muscle pain can be signs of liver disease. However, they are not always direct symptoms of it.
Liver disease is an umbrella term for various conditions that affect the liver. Some examples include:
- osteoporosis, a loss of bone density
- changes in bone mineral metabolism
- death of bone tissue
Cirrhosis is also a risk factor for complications following joint replacement surgery. It results in longer hospital stays, higher costs, and increased mortality rates.
There are several reasons why joint pain can develop in people with liver disease.
Lyme Disease How Can It Affect My Joints
26 May 2021
As the weather increases in temperature, so do the number of tick bites and cases of Lyme disease – an illness caused by a bacteria, Borrelia burgdorferi, which is transmitted by a deer tick bite. Typically, early symptoms of Lyme disease include fever, fatigue, and at times, a bullseye rash, called erythema migrans.
If an early infection is missed or is asymptomatic and left untreated, the disease can spread to the heart, nerves, brain, and even the joints, causing Lyme arthritis – inflammation in the joint tissue.
“Lyme arthritis most commonly affects one joint, typically the knee, and presents as pain and swelling without any injury or trauma,” explains Shawn Potteiger, D.O., sports medicine physician at Premier.
Additionally, when Lyme disease spreads, “Patients experience warm, swollen joints with increased pain when the knee or joint is fully straightened or bent,” states Itai Gans, M.D., sports medicine surgeon at Premier. “Joint swelling can increase and decrease, move between different joints and become quite painful, which can limit the ability to walk, at times,” says Gans.
Diagnosis for Lyme disease is done through lab testing. Luckily, the illness can successfully be treated with antibiotics. If joint swelling progresses, patients may need to seek orthopaedic care to treat fluid buildup.
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Other Integrative And Restorative Therapies
Modalities to help improve strength, mobility, and flexibility can help to relieve pain temporarily. Over time, improved function may help reduce the underlying cause of the pain. I am a big fan of hands-on treatment by a trained professional.
The following is a partial list of therapies you might consider.:
- Neuromuscular electrical stimulation
- Transcutaneous electrical nerve stimulation
- Ultrasound therapy
- Vagus nerve stimulation
What Are The Symptoms Of Lyme Disease
Signs and symptoms of early Lyme disease typically include:
- A reddish rash or skin lesion known as erythema migraines . The rash starts as a small red spot at the site of the tick bite anywhere from one week after to four weeks after the bite. The spot expands over a period of days or weeks, forming a circular, triangular or oval-shaped rash. The rash may look like a bulls eye because it appears as a red ring that surrounds a clear center area. The rash can range in size from that of a dime to the entire width of a person’s back. As infection spreads, several EM rashes can appear at different sites on your body.
Signs and symptoms of the second stage of Lyme disease may include:
- Multiple areas of rash.
- Paralysis of facial muscles .
- Heart block or an interruption of the electrical system of the heart.
- Areas of numbness or abnormal feelings .
Signs and symptoms of untreated late Lyme disease, which may happen from months to a year after infection, may include:
- Recurring episodes of swollen joints . This typically affects large joints like the knee.
- Difficulty concentrating, known as brain fog. This is a form of encephalopathy or damage to the brain.
- Damage to nerves all over your body, including your skin, muscles and organs .
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Lyme The Nervous System And Neuropathy
Unfortunately, once the infection begins to spread throughout the body, many people will develop Lyme neuroborreliosis . This is neurological Lyme disease, which affects and inflames the central and peripheral nervous systems.
Research suggests the neurologic manifestations of Lyme disease may be present in approximately 15% of the patient population. However, the exact incidence of LNB isnt well known. A brief stint in an online Lyme patient forum will quickly reveal that most individuals report experiencing at least some amount of neurological involvement on a routine basis.
One debilitating symptom that may be present among those with LNB is peripheral neuropathy . This is a disease process that impacts the nerves located outside of the brain and spinal cord. Neuropathy occurs when there is damage or dysfunction of neurons in one or more nerves.
The damage results in interference among the neurons, and they begin to have difficulty communicating with each other and the brain.
To make matters worse, co-infections like Babesia and Bartonella can contribute to neuropathy as well, according to a study in the International Journal of General Medicine.
So how do you know if the symptoms youre facing are neuropathy, and what can you do to find some relief? Read on to learn about the symptoms, diagnosis, and ideas on how to manage the pain and discomfort associated with neuropathy more effectively.
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.
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Diagnosis Of Lyme Arthritis
Like all proper diagnostic workups, it is essential to start with the history of the patient. In the case of tick-borne infections, it is important to know if there is a possibility the person may have been exposed to a tick prior to the onset of their symptoms. As mentioned previously, it can take up to two years for the pain caused by Lyme disease to manifest, so it is essential to review the patientâs history. Does the person spend time outdoors? Some activities increase exposure risks such as hiking, horseback riding, and camping, but people can also be exposed to ticks in parks, sports fields, in their yards, and from their pets bringing ticks into the house.
When children experience pain, they are often taken to their pediatrician who may not consider the diagnosis of Lyme disease. The same can occur for an adult with pain who presents to an orthopedist or sports medicine doctor.
On exam, the lining of the affected joint may be inflamed â called synovitis. Synovitis not only occurs in rheumatoid arthritis but also Lyme arthritis. Lyme arthritis rarely causes symmetrical joint involvement like rheumatoid arthritis, which can be helpful in making the correct diagnosis.
What Are The Risk Factors For Post Treatment Lyme Disease
Risk factors for Post Treatment Lyme Disease include:
- Delay in diagnosis
- Increased severity of initial illness
- Presence of neurologic symptoms
Increased severity of initial illness, the presence of neurologic symptoms, and initial misdiagnosis increase the risk of Post Treatment Lyme Disease. PTLD is especially common in people that have had neurologic involvement. The rates of Post Treatment Lyme Disease after neurologic involvement may be as high as 20% or even higher. Other risk factors being investigated are genetic predispositions and immunologic variables.
In addition to Borrelia burgdorferi, the bacteria that causes Lyme disease, there are several other tick-borne co-infections that may also contribute to more prolonged and complicated illness.
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Regression And Other Symptoms In Children
Children are the largest population of Lyme patients.
The CDC study of reported Lyme cases from 19922006 found that the incidence of new cases was highest among 5- to 14-year-olds . About one quarter of reported Lyme cases in the United States involve children under 14 years old .
Children can have all the signs and symptoms of Lyme that adults have, but they may have trouble telling you exactly what they feel or where it hurts.
You may notice a decline in school performance, or your childs mood swings may become problematic.
Your childs social and speech skills or motor coordination may regress. Or your child may lose their appetite.
Children are more likely than adults to have arthritis as an initial symptom 01267-2/fulltext#sec0040 rel=nofollow> 25).
In a 2012 Nova Scotian study of children with Lyme, 65 percent developed Lyme arthritis . The knee was the most commonly affected joint.
Summary:
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.
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What Does Lyme Arthritis Look Like
When Lyme disease is diagnosed in an acute stage with symptoms occurring soon after a tick bite, oral or intravenous antibiotic therapies may be sufficient for the majority of people to recover from LA. However, if treatment is delayed, due to circumstances like inadequate testing or misdiagnosis, arthritic symptoms caused by Lyme disease may develop weeks to months after initial exposure to infection. Additionally, research suggests that approximately 10% of people treated in the acute stage will continue to experience arthritis as well. But is that estimation really accurate?
In actuality, 10% percent is a ridiculously low number, says Dr. Bill Rawls, Medical Director of RawlsMD and Vital Plan. With poor testing measures for Lyme disease, we have no way to accurately evaluate patients, so that figure isnt correct. Its likely much higher.
Though there are discrepancies in the prevalence of LA, there are some frequent characteristics that can be seen in many patients. They include:
Can Lyme Disease Completely Be Cured
Taking oral antibiotics typically cures Lyme disease after two to four weeks. You may need to get antibiotics through the vein for four more weeks. However, theres no reason to think that Lyme disease stays in you forever after treatment.
A note from Cleveland Clinic
If youre going to spend time in an area that might have ticks, take measures to avoid being bitten. This includes wearing long-sleeved shirts and pants to make it harder for ticks to bite. If you feel sick after being in an area that probably has ticks, make an appointment with your healthcare provider. If your provider prescribes antibiotics, make sure you take all of them as instructed.
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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.
Lyme And Neuropathy: How To Ease Nerve Pain Tingling And Weakness
Lyme disease can affect several systems of the body the brain, nervous system, joints, heart, and more.
The list of symptoms infected individuals can experience is expansive and varies from person to person.
Its one of the reasons a Lyme disease diagnosis may be controversial.
Yet, one thing everyone seems to agree on about the tick-borne disease is that it can significantly impact the nervous system, especially without prompt treatment in the early stages of the infection.
Unfortunately, Lyme often goes missed early on. The telltale sign of a Lyme infection an erythema migrans rash, or the classic bulls-eye rash doesnt occur in every case. .
And the initial symptoms of infection may be nothing more than fever, chills, headache, fatigue, or muscle aches, making them easy to miss or brush off as a case of the flu.
But as the disease advances, the bacteria associated with Lyme, Borrelia burgdorferi, spreads via the bloodstream to other parts of the body, a process known as dissemination. This occurs in the days and weeks following infection, referred to as early disseminated Lyme disease.
If an infection goes untreated for months to years, however, theres a good chance the infection will proceed to late stage or late disseminated Lyme disease, sometimes called chronic Lyme disease. Thats when the nervous system can become involved, and symptoms ratchet up to a whole new level.
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