Lyme Disease And Joint Pain: Its Complicated
For starters, Lyme is complicated and every patient responds to the disease differently.
Approximately 30,000 new cases of Lyme are diagnosed each year, according to the CDC, and just over one-third of them develop arthritis as a symptom. The most common symptoms beyond the bullseye rash are chills, fatigue, headache/neck stiffness, fever. Painful and swollen jointsespecially in large joints such as the kneeare often considered a late-stage symptom of Lyme, but can appear even days after the tick bite.1-3 Some individuals may find out they have Lyme as a result of chronic joint painwithout ever knowing they had a tick bite.
Ticks rarely carry just one strain of bacteria. They usually deliver several different species of bacteria and parasites in one bite these are called co-infections. Co-infections are one reason Lyme disease diagnosis and treatment can be so complex and difficult.
To investigate why joint pain is a common symptom of Lyme disease, I spoke to Thalia Farshchian, ND, a naturopathic doctor practicing at Medical Options for Wellness, a clinic in Foster City, California. She specializes in treating patients affected by chronic and complex diseases, including Lyme disease.
It is estimated that about 70% of individuals presenting with bullseye rash do not recall a tick bite, she said. It is important to note that the absence of a rash does not rule out Lyme Disease as diagnosis, but may be supportive of the diagnosis.
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 .
Going For 1% Improvements
Tim was on the baseline menu and even though he wanted to try foods beyond phase 2, he had to keep coaching himself on the 1% philosophy. Clint advises that if you only feel 1% better by the end of the month, then just stick with it because the effect is cumulative and you will get there eventually.
Its helpful to think that a chronic condition takes time to develop and so it will take time to reverse but it is achievable.
Gao J, Gong Z, Montesano D, Glazer E, Liegner K. Repurposing Disulfiram in the Treatment of Lyme Disease and Babesiosis: Retrospective Review of First 3 Years Experience in One Medical Practice. Antibiotics . 2020 9:868. Published 2020 Dec 4. doi:10.3390/antibiotics9120868
Bodkhe R, Balakrishnan B, Taneja V. The role of microbiome in rheumatoid arthritis treatment. Ther Adv Musculoskelet Dis. 2019 11:1759720X19844632. Published 2019 Jul 30. doi:10.1177/1759720X19844632
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Staying Motivated While Working Through Lyme Disease And Rheumatoid Arthritis
It can be a challenge to stay focused on achieving optimum health when you have Lyme disease and rheumatoid arthritis. Tim talks about how long it took him to start to be able to reintroduce some troublesome foods, in his case, potatoes.
This is a sentiment that is often expressed by other members of the Paddison Program and it is entirely understandable. When our lifestyle is being able to eat whatever we want, changing our whole attitude to food takes commitment.
And Clint relates to this, he tells us that he had to adopt his goal to get well, as his lifes mission, before he started to see results. But it is achievable, and thats why Tims case study is so inspiring. He also discusses how his faith and love had an impact on his journey.
Recognizing Lyme Disease Causing Hip Problems In Children
Theres an old saying in medicine, If you hear hoof beats, think horses not zebras. It means to look for the obvious not search for strange, unusual causes of symptoms. But in the case of hip pain in children, it may be a zebra like Lyme disease. Most of the time, joint pain caused by Lyme disease affects the knee. But in a small number of cases, Lyme arthritis presents only in the hip.
Thats the conclusion of a group of pediatric orthopedic surgeons who studied their records of Lyme disease in children. Located in the northeastern region of the United States at the Childrens Hospital, this hospital is in an area where Lyme disease is very high.
Yet out of all the children treated at the hospital, only 73 cases of Lyme disease were reported between 1995 and 2009. And only eight of those cases were hip pain caused by Lyme arthritis. The children in the study ranged in ages from three to 20 years old. The symptoms presented included hip pain , refusal to put weight on that leg , and limp .
Fever was not a key feature for most of the children. None of the families were aware of any tick bites or unusual skin rashes. But lab values were suspicious with elevated white blood cell count and sed rate .
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What Is Rheumatoid Arthritis
Rheumatoid Arthritis affects the soft tissue around the joints, and its more common in women and usually occurs after middle age, but it can come on at any time. Rheumatoid Arthritis can cause deformities in the hands and feet and can affect other types of bodily tissue too. The exact cause of Rheumatoid Arthritis is unknown, but it may occur due to genetic or environmental factors or even past illnesses.
Rheumatoid is usually diagnosed with a blood test. X rays, physical examination, and lab tests. There is no cure for Rheumatoid Arthritis. Treatment options include surgery, anti-inflammatories for pain, physiotherapy, diet changes and self-management.
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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How Are Lyme And Rheumatoid Arthritis Different
Most of the time Rheumatoid Arthritis affects the hands and feet, but Lyme Arthritis usually occurs in larger joints such as the shoulders or knees. Also, Rheumatoid Arthritis is often symmetrical, so it affects the same parts of the body equally on both sides. Whereas Lyme Arthritis is usually asymmetrical and can affect one or several joints. Rheumatoid Arthritis pain is generally more severe and consistent than Lyme Arthritis because the symptoms of Lyme Arthritis can often come and go.
What Are The Symptoms
The main feature of Lyme arthritis is obvious swelling of one or a few joints. While the knees are affected most often, other large joints such as the shoulder, ankle, elbow, jaw, wrist, and hip can also be involved. The joint may feel warm to the touch or cause pain during movement. Joint swelling can come and go or move between joints, and it may be difficult to detect in the shoulder, hip, or jaw. Lyme arthritis typically develops within one to a few months after infection.
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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.
Is Lyme Disease A Rheumatoid Arthritis Mimic Or A Cause
Rheumatism Causes
Lyme illness is frequently misdiagnosed as rheumatoid arthritis or other autoimmune diseases. If left untreated, Lyme illness and RA can both become crippling. Symptoms of Lyme arthritis normally go away once the infection has been treated. Treatment for RA, on the other hand, can only reduce the diseases course rather than cure it.
Lyme disease could be the cause of intermittent arthritic symptoms in one joint. Its possible you have RA if you have pain and stiffness in your joints on both sides of your body every morning. A diagnosis of RA is more likely when you have RA risk factors.
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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.
Treatment Of Lyme Arthritis
Infection with the tick-borne spirochete Borrelia burgdorferi leads to an estimated 300,000 new cases annually of Lyme disease in the United States. The northeastern United States is the most affected region, but the infection is also found in mid-Atlantic states, the upper Midwest, and in California, and it now extends into Canada. Lyme borreliosis in also endemic in parts of Europe and Asia. In untreated patients, the infection generally occurs in stages, with different manifestations at each stage. The disease usually begins with an expanding skin lesion, erythema migrans, accompanied by flu-like symptoms. Weeks later, untreated patients may have neurologic involvement, characterized by lymphocytic meningitis, cranial neuropathy, or radiculoneuropathy, or they may develop carditis, frequently manifested as atrioventricular nodal block. These manifestations of the disease can usually be treated successfully with appropriate antibiotic therapy for 24 weeks.
This range of outcomes leads to a conundrum. Do LA patients with little or no apparent response to oral antibiotic therapy still have active B. burgdorferi infection requiring IV antibiotic therapy, do they have postinfectious LA requiring therapy with disease-modifying antirheumatic drugs , or do they have another form of chronic inflammatory arthritis? Either IV antibiotics or DMARD, given inappropriately, might be harmful.
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Leaky Joint Pain Particularly Characteristic
Particularly characteristic is that the pain of the joints, or the inflammation at the individual joints jump back and forth. Sometimes the knee is affected, then the hip or ankle.
External signs of joint inflammation by borrelia are a swelling and severe redness as well as an overheating. Usually the knee joint is inflamed, but the ankle or the elbow may be affected.
According to estimates, approximately 50-75% of patients who develop lateborreliose suffer from arthritis. Recent studies suggest that the incidence of actual arthritis in patients with chronic Lyme disease or late borreliosis is less than 25%. Also, toothaches or pain in the temporomandibular joints are not uncommon .
Your Symptoms Improve When Youre Taking Medication For Other Ailments
Patients taking antibiotics for an unrelated problem , will often report that their symptoms are much better while taking the antibiotic, and worsen when the antibiotic is stopped. Conversely, some individuals feel much worse on antibiotics, where all of their symptoms are intensified. This is called a Jarisch-Herxheimer reaction, where the Lyme bacteria are being killed off, and temporarily worsen the underlying symptoms.
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Lyme False Negatives And False Positives
The tests have been criticized by some for showing false negatives during the early stages of Lyme. But at the point where Lyme arthritis comes along, those tests should definitely be positive, says Dr. Lewandowski.
False positive Lyme test results can also throw a wrench into a Lyme arthritis diagnosis. This is when the test says you have Lyme disease but you actually dont.
In patients who have infectious mononucleosis or test positive for an antibody called rheumatoid factor , those other conditions could cross-react with the Western blot test and make it look like you have Lyme when its actually something else, according to a study in Pediatric Rheumatology. RF is associated with rheumatoid arthritis, so theres a chance that rheumatoid arthritis could be the real root of the joint pain.
However, rheumatoid arthritis tends to be symmetric, but Lyme arthritis rarely is, which could be a sign that it isnt Lyme after all.
If antibiotics for Lyme treatment dont seem to be working, a doctor can test fluids from the knee for signs of Lyme, says Dr. Law. A negative test would indicate the Lyme has cleared out and something else is causing the pain.
In rare instances, the initial Lyme infection can trigger a separate autoimmune condition, adds Dr. Lewandowski. In that case, the antibiotics should be dropped in favor of a new treatment plan such as anti-inflammatory drugs.
Practical Assessment And Treatment Of Pain Arthritis And Fibromyalgia In Lyme Disease
Pain is common in early and late-stage Lyme disease. The first, and most important, step is proper testing to determine if Lyme disease and/or associated infections are the cause of the pain. Bacteria from tickborne infections can directly damage joints, trigger an immune response that creates inflammation, and cause an autoimmune reaction that leads to pain.
If symptoms such as fatigue, headaches, fevers, or brain fog are present along with pain, this suggests a systemic infection may be involved. Infections can trigger autoimmune conditions such as rheumatoid arthritis and lupus, so a thorough investigation is warranted. Multiple therapies can help reduce pain and inflammation caused by Lyme disease and associated infections, but ultimately successful treatment of the infections is most important.
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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 Elżbieta 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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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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