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.
Reasons To Choose Herbs
Plants have to deal with a wide range of microbes, including bacteria, viruses, protozoa, and fungi, just like any other living creature. Not having an immune system, plants deal with the problem by producing a sophisticated spectrum of biochemical substances called phytochemicals. Instead of one chemical, like an antibiotic, a medicinal herb contains hundreds of phytochemicals that suppress microbes in different ways therefore resistance is almost unheard of, even with very long-term use. Some herbs provide more potent antimicrobial properties than others. While herbs would never be a good choice for treating a life-threatening illness like pneumonia, they are perfect for suppressing stealth microbes associated with chronic illness.
Different herbs offer a slightly different range of benefits, therefore multiple herbs can be used together to cover for all possible stealth microbes involved. In fact, this is the preferred way of doing herbal therapy . This provides for a wide spectrum of activity against a wide range of microbial threats. You can think of it as an orchestra of healing the sum of multiple herbs is more powerful than each herb individually.
Over the millennia, humans naturally selected certain plant substances for use as medicines. These plants, now known as medicinal herbs, have chemistry that meshes well with human biochemistry. Not surprisingly, medicinal herbs are well tolerated by most people and can be safely used for extended periods of time.
Who Gets Psoriatic Arthritis
Psoriatic arthritis has an incidence of approximately 6 per 100,000 per year and a prevalence of about 12 per 1000 in the general population. Estimates of the prevalence of psoriatic arthritis among patients with psoriasis range between 4 and 30 per cent. In most patients, arthritis appears 10 years after the first signs of skin psoriasis. The first signs of psoriatic arthritis usually occur between the ages of 30 and 50 years of age. In approximately 1317% of cases, arthritis precedes the skin disease.
Men and women are equally affected. The symptoms of psoriatic arthritis come and go but it is a lifelong condition that is usually progressive.
Patients with psoriasis who are more likely to subsequently get arthritis include those with the following characteristics:
- Elevated C-reactive protein at baseline.
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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.
Current Challenges And Future Priorities
Patients with PTLD represent a substantial burden to the United States health care system. In a large, health insurance claims analysis of 47 million members, estimated total direct medical costs from Lyme disease were between $712 million and $1.3 billion per year, with a significant portion of these specifically due to PTLD-related costs . The same study found that the adjusted odds of any PTLD-related symptom diagnosis following Lyme disease was 4.77 higher than age-, sex-, enrollment year-, region- and payer type-matched controls without Lyme disease, and that those patients with Lyme disease who went on to have at least one PTLD symptom had over twice the average total health care costs as those who did not . These cost estimates do not reflect additional indirect, non-medical, and lost productivity costs to patients, which may be substantial in a population with a chronic and significant illness impact on quality of life . Novel preventative approaches to reduce incidence of new Lyme disease cases, as well as physician and community educational interventions to increase awareness and reduce diagnostic delays and misdiagnosis, are needed to reduce costs and improve patient outcomes.
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Severity Assessment In Psa
Patients may be roughly stratified in categories of mild, moderate, or severe for peripheral arthritis, skin disease, spinal disease, enthesitis and dactylitis according to presence of criteria noted in . This table is designed to be used as a tool to assist in decision making, and rigorous adherence to the proposed stratification is not appropriate. Until numeric thresholds for mild, moderate and severe for the various instruments are validated, doctor judgment is required to appropriately stratify individual patients. Some patients may have multiple manifestations, and treatment decisions may be determined by the most severe clinical presentation. The synergistic impact of multiple simultaneous manifestations may be assessed with the patient global assessment, HAQ and disease-specific instruments . Two case descriptions are provided in .
Case descriptions
Acr : What Rheumatologists Need To Know About Lyme Disease And Tick
Lyme disease is a complex infectious disease caused by Borrelia burgdorferi andtransmitted through infected Ixodes ticks. Annually, more than 30,000 new cases of Lyme disease are reported to the Centers for Disease Control and Prevention however, the true incidence is estimated at more than 450,000 cases each year.1 The incidence of Lyme disease and its distribution in the US and Canada are increasing.2
Early Lyme disease is sometimes characterized by fever, headache, fatigue, and erythema migrans. A second phase may include facial palsy or other neurologic symptoms. Many patients do not notice their symptoms or seek treatment in these phases. Untreated, late Lyme disease arthritis can develop months or years after infection. In addition, a spectrum of inflammatory or noninflammatory conditions can develop after Lyme disease treatment, including: postinfectious Lyme arthritis, post-treatment Lyme disease syndrome, and systemic autoimmune diseases.3
The American College of Rheumatology Convergence 2021 featured a scientific session titled, Lyme Disease & Other Tick-Borne Illnesses: What Every Rheumatologist Must Know,3 that was aimed at informing rheumatologists about these conditions.
Robert Kalish, MD, director of Rheumatology Education at Tufts Medical Center moderated the session, and the presenters included John Aucott, MD, Johns Hopkins University School of Medicine, Baltimore and Sheila Arvikar, MD, Massachusetts General Hospital, Boston.
Late Lyme Disease Arthritis
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Situations Where The Addition Of Synthetic Antibiotics May Prove Beneficial
- Ehrlichia, anaplasma, and rickettsia. These microbes have a higher potential to cause severe disease and less likelihood of chronic disease after treatment of the initial infection. When chronic disease does occur, it is generally characterized by long asymptomatic periods with the microbe hidden in isolated locations in the body followed by relapse of acute symptoms . Relapses should be treated like an initial infection with doxycycline 100 mg twice daily for 30 days or until 3 days after symptoms subside.
- Chronic babesia infection. Babesia is characterized by relapsing high fever or positive test for babesia . Sometimes triple antibiotic therapy is required to eradicate severe babesia infection. Current guidelines for babesia should be followed. Natural therapy for protozoan infections can accompany conventional therapy.
- Persistent severe Lyme symptoms refractory to natural therapy. If chronic infection has been present long term and a persons immune status is severely depressed, pulsed antibiotic therapy may provide benefit . Antibiotics should never be continued for more than 30 days at a time and a 30 day break should be taken between episodes of antibiotics to allow the system to recover. Rotating different antibiotics may decrease bacterial resistance. Whether to use multiple antibiotics simultaneously is unknown and may disrupt the microbiome even further.
Connections To Chronic Illness
Whether you are symptomatic or not depends a lot on the health of your cells. Your cells are not defenseless!
All of our cells have an internal housekeeping system called autophagy. Cells continually break down misfolded proteins, burned-out mitochondria, damaged DNA, and worn-out parts and recycle them into new proteins and cell parts. It is also the mechanism by which cells expel many types of intracellular microbes. The fact that our cells can expel intracellular microbes is another important and often unrecognized part of our natural defenses.
But when cells are chronically exposed to poor nutrition, toxic environment, chronic mental stress, and sedentary lifestyle, auto-nagy is impaired and cells become more vulnerable to invasion by intracellular pathogens. Increased cellular turnover and increased microbe activity overtaxes the immune system. At a certain point, a threshold is crossed, such that symptoms occur. The type of symptoms that occur depends on the types of cells affected different microbes have preference for different types of cells in the body. This is one reason why there are so many different chronic illnesses.
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Real Solutions For Chronic Immune Dysfunction
I divide options for overcoming illnesses associated with Chronic Immune Dysfunction and stealth microbes into two categories: Heroic Therapies and Restorative Therapies.
A third category of solutions, Symptomatic Therapies, is best reserved for acute relief. Specifically directed at controlling symptoms, Symptomatic Therapies come mostly in the form of prescription drugs and contribute only minimally to healing and wellness.
Lyme Disease And Rheumatoid Arthritis: Similarities Differences And Why A Misdiagnosis Can Be Deadly
Because its symptoms mimic those of so many other diseases both tick-borne and otherwise Lyme disease is often misdiagnosed. One of the most common Lyme disease misdiagnoses is Rheumatoid Arthritis , a chronic condition with less clear causes than Lyme disease.
Though there are many fundamental differences between these two conditions, its true that arthritic pain stemming from Lyme disease can often look like RA. In fact, Lyme was first discovered and documented in part because of a group of children presenting with arthritis symptoms in Lyme, Connecticut.
So, if youre experiencing joint pain, how can you tell the difference? If youve been bitten by a tick or think youre at risk for a tick-borne disease, its extremely important not to delay seeking medical attention or ignore any arthritic pain that might be associated with Lyme disease. Continue reading to better understand the differences and similarities between Lyme disease and arthritis.
Lyme Disease: Causes and Risk Factors
Lyme disease is a tick-borne infectious disease caused by the spiral-shaped bacteria Borrelia burgdorferi sensu lato. Though Lyme is treatable with antibiotics, it can worsen, change symptoms, spread to the neurological system, become a chronic condition, and even become life-threatening if not diagnosed and treated right away.
Common Symptoms of Lyme Disease
Early Lyme Disease Symptoms
- Bulls eye rash, or Erythema Migrans
Late Stage Lyme Disease Symptoms
- Facial drooping
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Guidelines For Antibiotic Use
Dr. Rawls is a physician who overcame Lyme disease through natural herbal therapy. You can learn more about Lyme disease in Dr. Rawls new best selling book, Unlocking Lyme. You can also learn about Dr. Rawls personal journey in overcoming Lyme disease and fibromyalgia in his popular blog post, My Chronic Lyme Journey.
Lyme Disease Often Leads To Lyme Arthritis
Although Lyme disease may affect many organs, such as the heart and nervous system, joint involvement tends to be the most common and persistent manifestation, resulting in joint swelling and pain. About 60% of people who are infected with Lyme develop arthritis unless they receive antibiotics.
In most, Lyme arthritis resolves after 30 days of treatment with an oral antibiotic, such as doxycycline or amoxicillin. Individuals with persistent symptoms despite an oral antibiotic usually respond to treatment with an intravenous antibiotic for 30 days. However, about 10% of those with Lyme arthritis fail to respond to antibiotic treatment, for reasons that have long been unclear.
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Clinical Characteristics Of Patients
During the 13-year period in which we have been at MGH, 30 patients were referred to us for evaluation of presumed LA in whom we diagnosed a systemic autoimmune joint disorder. Of the 30 patients, 15 had new-onset RA, 13 had new-onset PsA, and 2 had new-onset peripheral SpA. The median duration from the onset of Lyme disease to the start of joint symptoms was 4 months , which is similar to the time frame in which LA may occur after EM .
Duration from Lyme disease to onset of rheumatoid arthritis , psoriatic arthritis or peripheral spondyloarthropathy . For comparison, the duration from erythema migrans, the initial skin lesion of the infection, to onset of Lyme arthritis is shown for historical patients seen in the late 1970s who were not treated with antibiotic therapy . Thus, the duration from erythema migrans to the development of arthritis was known.
The number of patients referred for presumptive Lyme arthritis over a 13-year period, according to the year of referral. The patients were stratified into 3 groups according to our diagnoses of post-Lyme systemic autoimmune joint diseases, antibiotic-refractory Lyme arthritis, or antibiotic-responsive Lyme arthritis.
Healthy Cells Equal A Healthy Body
The human body is a complex collection of living cells. When all the cells in the body are healthy and working in unison, you feel well. Symptoms occur when cells are stressed. Sometimes the symptom points to the source of stress: for example, joint pain indicates that cells in the joints have been taxed or injured. Symptoms like fatigue, however, suggest that cells throughout the body are overburdened, and communications that unify cellular functions have been compromised.
Fortunately, cells can recover from being stressed its what healing is all about. Cells can repair internal damage, and even when theyre injured beyond repair, other cells in the body can divide to make replacements . That is, if the stress resolves or is relieved.
Chronic illness occurs when stress never resolves, and our cells dont get a chance to recover from being overworked. There are many different chronic illnesses because different cells in the body can become chronically stressed in different ways.
The immune system plays an enormous role in the healing process. Its responsible for removing old and abnormal cells, cleaning up cellular debris and dead microbes, clearing foreign substances from the bloodstream, and purging toxins from the body. During chronic illness, cellular turnover is increased to the point that the immune system becomes overtaxed. When the immune system cant do its job, all cells in the body suffer.
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Borrelia The Misunderstood Microbe
Retrospectively, I may have harbored Borrelia burgdorferi for years before I actually developed symptoms. Im an outdoor person tick bites have always been a common affair.
Its not uncommon for people to harbor borrelia and not know it stealth is this microbes middle name.
Lyme disease is mostly transmitted by nymphal ticks, which are about the size of a pin. They bite, transmit the microbe, and then drop off most people arent even aware of being bitten. Because symptoms of the initial infection are so mild , its not uncommon for people to be completely unaware of being infected.
And borrelia isnt the only microbe to worry about. Ticks carry many microbes that have similar characteristics to borrelia. What they all have in common is stealthy characteristics that make them hard to find and even harder to get rid of.
If immune system function is robust, a person can harbor these types of microbes indefinitely, keeping them in check without ever having symptoms. When illness does occur, its typically chronic and debilitating, but not life-threatening. Additionally, the degree of chronic illness is highly variable. Some people are severely debilitated, while others are only marginally miserable.
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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Boiling Point: The Lyme + Fibromyalgia + Chronic Fatigue Connection
The misery of chronic illness is very real. But if youre the one whos suffering, you know that those around you typically cant see it or understand it not family, friends, or even medical providers.
They dont know what its like:
to push through oppressive fatigue day after day.to be tired beyond exhaustion but unable to sleep.to ache all over so badly that all you want to do is curl up in a ball inside a dark closet.to feel like you have the flu every day of your life but still have to go to work.to be isolated, both socially and professionally.to have bizarre symptoms that no one can put a finger on.to be told that all your lab tests are normal, even though something is obviously wrong.to become dependent on symptom-suppressing drugs prescribed by well-meaning doctors who didnt know enough to know better.
I can relate better than most doctors because Ive lived it. I am part of a growing epidemic of people suffering from chronic ailments that the modern medical system is at a loss to help.
An unexpected twist during my late 40s changed my life and career path forever. Unrelenting stress from a too-busy medical practice combined with an entanglement of unpredicted life stressors plunged me into chronic misery that took me 10 years to escape.
Then, I became the patient I could almost sense my doctors roll their eyes the minute I came through the door.
