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 .
Lyme Arthritis: A Small Piece Of The Larger Autoimmunity Puzzle
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Spotting and managing early Lyme disease can be easy: Just look for the bullseye. But when the rash goes away and the infection remains untreated for a prolonged period, Lyme arthritis can develop. That is when the real challenges begin.
To be fair, even Lyme arthritis can be easily recognizable, according to Robert Kalish, MD, rheumatologist and director of rheumatology education at Tufts Medical Center. Lyme arthritis is generally going to be a swollen knee in around 90% of patients, he told Healio Rheumatology.
Clinically, the knee or knees have a large effusion even after joint aspiration,Cassandra Calabrese, DO, of the department of rheumatologic and immunologic disease at the Cleveland Clinic, added.
Calabrese noted that the remainder of cases can manifest as persistent or intermittent pain and swelling in other larger joints, such as the shoulders, ankles or elbows. It can go on for years, generally being more persistent than intermittent, she said.
Beyond the Bullseye
Rheumatologists have played a pivotal role in the story of Lyme disease since it was first discovered by Steere in 1976, following an outbreak of juvenile arthritis or arthritis of unknown cause in Lyme, Connecticut.
Robert Kalish, MD,
Lyme Disease Vs Juvenile Idiopathic Arthritis
Lyme arthritis is most common in 7- to 10-year-olds, so it tends to be confused with juvenile idiopathic arthritis , a type of inflammatory arthritis that affects young children, says Dr. Lewandowski. If a child lives outside the areas where Lyme is common New England, the Mid-Atlantic, Wisconsin, and Minnesota its more than likely JIA, not a tick-borne disease.
To answer the JIA vs. Lyme arthritis question, doctors can test patients for signs of Lyme disease. The first step is to test for antibodies with an enzyme-linked immunosorbent assay test. If that comes back positive, a doctor will likely order something called a Western blot test, which will show certain darkened bands if there are antibodies fighting a Borrelia burgdorferi infection.
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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.
How To Avoid Tick Bites
To reduce the chance of being bitten:
- cover your skin while walking outdoors and tuck your trousers into your socks
- use insect repellent on your clothes and skin products containing DEET are best
- stay on clear paths whenever possible
- wear light-coloured clothing so ticks are easier to see and brush off
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Expert Care For Joint Pain From Lyme Disease
At, Aurora Health Care, our team of more than 80 orthopedic specialists has years of experience and training caring for people with joint pain and other problems, like arthritis. This has led to fast and accurate diagnoses for the people we treat so they can return to their busy lifestyles.
Highlights of our program also include:
Ongoing Symptoms Of Lyme Disease
A few people who are diagnosed and treated for Lyme disease continue to have symptoms, like tiredness, aches and loss of energy, that can last for years.
These symptoms are often compared to fibromyalgia and chronic fatigue syndrome.
It’s not clear why this happens to some people and not others. This means there’s also no agreed treatment.
Speak to a doctor if your symptoms come back, or do not improve, after treatment with antibiotics.
The doctor may be able to offer you further support if needed, such as:
- referral for a care needs assessment
- telling your employer, school or higher education institution that you require a gradual return to activities
- communicating with children and families’ social care
Page last reviewed: 05 July 2021 Next review due: 05 July 2024
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What Should I Do If I Am Bitten By A Tick
If you experience a tick bite, the best way to remove it is by taking the following steps:
- Tug gently but firmly with blunt tweezers near the “head” of the tick at the level of your skin until it releases its hold on the skin.
- Avoid crushing the tick’s body or handling the tick with bare fingers as you could exposure yourself to the bacteria in the tick.
- Wash the bite area thoroughly with soap and water.
- DO NOT use kerosene, petroleum jelly , or hot cigarette butts to remove the tick.
- DO NOT squeeze the tick’s body with your fingers or tweezers.
How You Get Lyme Disease
If a tick bites an animal carrying the bacteria that cause Lyme disease, the tick can become infected. The tick can then transfer the bacteria to a human by biting them.
Ticks can be found in any areas with deep or overgrown plants where they have access to animals to feed on.
They’re common in woodland and moorland areas, but can also be found in gardens or parks.
Ticks don’t jump or fly. They climb on to your clothes or skin if you brush against something they’re on. They then bite into the skin and start to feed on your blood.
Generally, you’re more likely to become infected if the tick is attached to your skin for more than 24 hours. Ticks are very small and their bites are not painful, so you may not realise you have one attached to your skin.
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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.
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:
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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
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.
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Causes And Symptoms Of Lyme
Lyme arthritis is not the same as chronic Lyme disease. Instead, it is connected more to late-stage Lyme disease. There are specific symptoms or traits of Lyme arthritis, like the fact that the pain it causes is not chronic and is not enough to keep someone from walking, even though it is painful.
Lyme arthritis does not usually affect all joints of the body. Instead, five or fewer joints feel inflamed, swollen and painful at a time. The bones that feel pain can vary during each attack though. The pain associated with Lyme arthritis is also not symmetric on both sides. Meaning, if your left knee is swollen and feeling pain, that does not mean your right knee will be affected too. The joints affected can appear random during each attack.
Occasionally, Lyme arthritis can make parts of your body swell and turn red and look very painful, when in fact, the pain is not as bad as it seems. Just the opposite can happen also. You may not see any external signs of inflammation or swelling, but your joints could be in acute pain.
Lyme Arthritis: Symptoms Diagnosis And Treatment
According to the Lyme Disease Association, Lyme disease is affecting people worldwide and is in more than 80 countries worldwide. The Center for Disease Control defines Lyme disease as:
A systemic, tick-borne disease with protean manifestations, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities.
Initial symptoms may include a rash that appears like a bullseye around the spot of the tick bite. Lyme disease can affect the nervous, musculoskeletal, and cardiovascular systems.
Additional symptoms are feeling tired for no specific reason, flu-like symptoms, stiff neck, myalgia, and arthralgia. Lets focus on arthralgia, also referred to as arthritis, among people living with Lyme disease.
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The Chance Of Getting Lyme Disease
Not all ticks in England carry the bacteria that causes Lyme disease.
But it’s still important to be aware of ticks and to safely remove them as soon as possible, just in case.
Ticks that may cause Lyme disease are found all over the UK, but high-risk places include grassy and wooded areas in southern and northern England and the Scottish Highlands.
Ticks are tiny spider-like creatures that live in woods, areas with long grass, and sometimes in urban parks and gardens. They’re found all over the UK.
Ticks do not jump or fly. They attach to the skin of animals or humans that brush past them.
Once a tick bites into the skin, it feeds on blood for a few days before dropping off.
How To Prevent Tick
High-risk regions for infection include the Atlantic coast from Maine to Virginia, as well as Minnesota, Wisconsin, and Michigan. Lyme disease was once rare in Canada, but has been steadily ratcheting its range northward as a result of climate change.
If you live in an area where Lyme disease is common, some simple steps can minimize the risk of tick bites:
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Risk Factors For Acquiring Lyme Disease
Where you vacation or live, as well as what outdoor activities you participate in, affects your likelihood of being exposed to Lyme disease. Common factors that put you at risk of contracting Lyme disease include:
- Spending time in grassy or wooded areas. Deer ticks are very prevalent in the Central PA area due to its heavily wooded countryside. Deer ticks thrive in these types of places. Children here are particularly at risk as well as adults who work outdoors.
- Having exposed skin. Ticks find it easy to attach themselves to exposed skin, so if youre in an area thats known for ticks, always wear long sleeves and long pants and never allow your pets to run through long grasses.
- Removing ticks incorrectly or not quickly enough. As you already know, bacteria from a tick bite has the potential to enter your bloodstream if the tick has been attached to you for between 36 to 48 hours or longer. If you spot and correctly remove the tick within 48 hours, your risk of acquiring Lyme disease is low, so always check your skin after being outdoors.
The Centers for Disease Control and Prevention notes that older adults and children are most susceptible to the disease, along with others, like park rangers and firefighters, who spend time outside. Its estimated that 300,000 people nationwide are diagnosed with Lyme disease each year.
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.”
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What Are The Second Stage Signs And Symptoms Of Lyme Disease
The symptoms of second stage, early disseminated, Lyme disease can be difficult to attribute. Symptoms include severe fatigue, fever, pain, intermittent weakness and achiness of the muscles and joints, numbness in arms and legs, vision changes, and cognitive dysfunction such as short-term memory difficulties and problems multitasking. These symptoms are not specific for Lyme disease and can make the diagnosis of second stage Lyme disease very challenging.
More recognizable Lyme disease nervous system manifestations include facial paralysis , or meningitis with severe headache and stiff neck. Notable cardiac manifestations include passing out or feeling faint from an abnormally slow heart rate, irregular heart palpitations, or unexplained difficulty tolerating exercise. Meningitis and carditis are both potentially serious Lyme disease conditions and warrant immediate medical attention.
Fragments From Lyme Bacteria Persist In Joints Even After The Bacteria Are Killed Off
A new study published in Proceedings of the National Academy of Sciences sheds light on this medical mystery. To keep from spilling open, bacteria have rigid cell walls made of a matrix of protein and sugars, called peptidoglycan. Most bacteria recycle their peptidoglycan when they grow and divide, but the peptidoglycan of B. burgdorferi has a peculiar structure, and the bacteria is unable to reuse it. Instead, it dumps it into its immediate surroundings, like a microbial litterbug.
This peptidoglycan collects in the joints where B. burgdorferi is found. Almost all patients in the PNAS study with Lyme arthritis had peptidoglycan in their joint fluid. Most of them also had specific antibodies to peptidoglycan in the joint fluid, suggesting that the peptidoglycan was driving the inflammatory process. These antibodies were not found in fluid from people with other joint conditions, such as rheumatoid arthritis, osteoarthritis, or gout.
Patients with Lyme arthritis who did not get better with antibiotics still had peptidoglycan in their joint fluid. However, their joint fluid did not contain detectable B. burgdorferi DNA. This suggests that even after the bacteria were killed off, the peptidoglycan stayed behind, and stimulated further inflammation. This may explain why people with Lyme arthritis who do not respond to antibiotics may improve with medications that damp down the immune system, such as methotrexate or TNF inhibitors.
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