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.
Nutritional And Immune Support
The Case of Sarah Statesmyer
Sarah Statesmyer, age 16, came to the office of Robin Ellen Leder, M.D.,29 in Bronx, New York, complaining of severe fatigue and episodes of debilitating joint pain, especially in her knees. Low energy made it extremely difficult for Sarah to do her work at a law firm on her bad days. She felt like she could barely walk. Her symptoms, she reported, had been ongoing since childhood.
Sarah’s parents thought her problem stemmed from a tick bite years earlier, but a blood test was only suggestive of Lyme Arthritis Disease, and was not conclusive, probably because of the time that had passed since Sarah’s first exposure to the Borrellia burdorfi organism. However, because of the described symptoms and probable history of Lyme Arthritis disease, this condition was considered to be the most likely cause of Sarah’s problem.
Dr. Leder discussed traditional, possibly long-term, antibiotic therapy with Sarah, and also the importance of supporting the immune system in chronically symptomatic Lyme Arthritis Disease patients.
Sarah and her family chose to begin treatment using the nutritional approach offered by Dr. Leder.
To help design a diet that would benefit Sarah, Dr. Leder began by having Sarah take a six-hour glucose tolerance test and a special blood test for food allergies. She was found to be quite hypoglycemic , and also to have sensitivities to a number of foods.
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.
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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.
Lyme Arthritis: Highly Treatable Slow To Resolve
EXPERT ANALYSIS FROM THE ANNUAL PEDIATRIC INFECTIOUS DISEASES CONFERENCE SPONSORED BY CHILDREN’S HOSPITAL COLORADO
VAIL, COLO. Arthritis is far and away the most common manifestation of late Lyme disease, affecting up to 30% of children whose early-stage disease went untreated.
Lyme arthritis presents with a distinctive clinical picture. Nevertheless, this common condition is often initially mismanaged as a joint sprain or other orthopedic injury, with the correct diagnosis coming only following referral after a month or more with no improvement, according to Dr. Roberta L. DeBiasi, acting chief of the division of pediatric infectious diseases at Childrens National Medical Center, Washington.
Dr. Roberta L. DeBiasi
“We see tons of kids with Lyme arthritis. We get two or three cases every week in our clinic,” she said at the conference.
Lyme arthritis occurs months to years after an untreated exposure to Borrelia burgdorferi. Affected patients typically present with a history of recurrent, weeks- or months-long attacks of joint swelling in one or a few joints. The knee is by far the most common site, but other large joints can be involved, as can the temporomandibular joint. An involved knee may swell up to literally the size of a basketball, yet the child has no fever, erythema, or systemic complaints, and surprisingly little pain given the effusion size.
Dr. DeBiasi reported having no financial conflicts.
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How Is Lyme Disease Diagnosed
Your doctor will diagnose you based on your symptoms and whether youâve been exposed to a tick. They might also run a blood test. In the first few weeks of infection, the test may be negative because antibodies take a few weeks to show up.
Hopefully soon, there will be tests that can diagnose Lyme disease in the first few weeks after youâre exposed. The earlier you get treated, the less likely itâll get worse.
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
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When Lyme Disease Isnt Caught And Treated Early It Can Cause Late
If youre from a certain area, you know at least a little about Lyme disease. Its the reason your parents made you cover up any time youd be remotely close to a wooded area and checked you religiously for ticks upon your return home.
Lyme disease is an infectious disease spread by certain ticks in certain parts of the United States and Europe. Early on, it can cause flu-like symptoms and a telltale bulls-eye rash. But if Lyme disease isnt caught and treated with antibiotics promptly, the infection can eventually spread through the body. The most common late-stage symptoms include joint swelling and pain, a condition known as Lyme arthritis.
Historically, about 60 percent of people with undiagnosed, untreated Lyme disease would develop Lyme arthritis, according to a study in the journal Arthritis & Rheumatology.
Lyme arthritis, however, shouldnt be confused with chronic Lyme. As its name implies, chronic Lyme is a condition that doesnt go away with one course of antibiotics. Its controversial in the medical world, partly because some patients are diagnosed with chronic Lyme when lab tests dont show evidence of an infection. Some doctors insist that chronic Lyme patients symptoms fade when they stay on antibiotics others argue that its a different disease entirely and that long-term antibiotics will only create more side effects.
Late-stage Lyme, on the other hand, is curable Lyme disease thats progressed and lead to complications such as arthritis.
How And Why Does Arthritis Present In Lyme Disease
The reason people get symptoms of arthritis when they contract Lyme disease has to do with how the bacteria B. burgdorferi functions in your body. Bacterium protects itself with walls made of proteins and sugars. These are called peptidoglycan. The peptidoglycan helps bacteria divide and grow and spread.
However, with B. burgdorferi, it cannot do this. The proteins and sugars are primarily useless to the bacteria associated with Lyme disease. So, because it cant be used, B. burgdorferi dumps the peptidoglycan wherever it can in your body.
Most of the time, this dumping goes into your joints. Both sugars and proteins like these can cause inflammation. And this can happen even when the bacteria have been killed off. In this study, it was found that patients whose symptoms did not improve even after taking antibiotics, still had peptidoglycan in the fluids in their joints.
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What Are The Symptoms Of Lyme Disease
Symptoms can start anywhere from 3 to 30 days after the bite. They may look different depending on the stage of your infection. In some cases, you wonât notice any symptoms until months after the bite.
Early symptoms include:
Without treatment, symptoms can get worse. They might include:
- Severe headache or neck stiffness
- Rashes on other areas of your body
- Arthritis with joint pain and swelling, particularly in your knees
- âDroopingâ on one or both sides of your face
- Inflammation in your brain and spinal cord
- Shooting pains, numbness, or tingling in your hands or feet
What does the rash look like?
Some Lyme rashes look like a bull’s-eye with circles around the middle. But most are round, red, and at least 2 inches across.
The rash slowly gets bigger over several days. It can grow to about 12 inches across. It may feel warm to the touch, but itâs usually not itchy or painful. It can show up on any part of your body.
How small are ticks?
Ticks come in three sizes, depending on their life stage. They can be the size of a grain of sand, a poppy seed, or an apple seed.
Later Symptoms And Signs Of Lyme Disease
If you dont seek treatment, other symptoms and signs of infection may appear over the following weeks and months, including:
- The bulls eye rash. It is also called erythema migrans, and it may appear on other areas of your body.
- Neurological problems. At any time after the initial Lyme disease infection, even years later, you could develop meningitis, Bells palsy , weakness or numbness in your limbs and impaired muscle movement.
You may also suffer from:
- Other rashes
Many weeks after infection, some people develop:
- Severe fatigue
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How Do You Get Lyme Disease
In the U.S., Lyme disease is carried primarily by deer or blacklegged ticks, and it is caused by the Borrelia mayonii and Borrelia burgdorferi bacteria. Its easy to be bitten by ticks in high-risk areas such as Central PA. The creatures are often no bigger than a poppy seed, so they are very difficult to see before they latch on.
However, not all ticks are Lyme disease carriers. To contract the disease, an infected tick needs to bite you. Bacteria from the tick will eventually make its way from the bite through to your bloodstream, usually taking between 36 to 48 hours. For this reason, whenever youve been in the outdoors, particularly in a known tick-heavy area, you should always check your body for parasites before you come back inside.
In the two primary stages of life, U.S. deer ticks feed on rodents, which are a prime source of the bacteria that causes Lyme disease. Ticks move onto feeding primarily on white-tailed deer when they reach adulthood.
If you find a swollen tick attached to you, it could have fed for long enough to transmit bacteria and should be removed with tick tweezers as soon as possible to prevent infection.
Synovial Fluid Analysis Imaging And Other Tests
On presentation, joint aspiration is usually done for diagnostic purposes to rule out the presence of other arthritides such as crystalline arthropathy or staphylococcal septic arthritis. Joint fluid white cell counts are usually inflammatory in the range , but cell counts as low as 500 or as high as 100,000 cells/mm3 have been reported. Although tests for rheumatoid factor or antinuclear antibodies typically yield negative results, antinuclear antibodies in low titer may be detected. Peripheral white blood cell counts are usually within the normal range, but inflammatory markers, such as ESR and CRP, may be elevated. Imaging studies are not required for diagnosis or are not typically performed. The major reason for imaging studies in Lyme arthritis is when there are concerns for alternative diagnoses.
In patients with Lyme arthritis, plain films, MRI scanning or ultrasound typically show non-specific joint effusions, while MRI studies utilizing contrast dye, may display synovial thickening or enhancement. In adult patients, imaging studies may show co-incidental degenerative changes or chronic mechanical injuries, but these abnormalities would not be expected to cause significant synovitis or inflammation. Lyme arthritis is not rapidly erosive, but with longer arthritis durations, joint damage can be seen on radiographic studies. Finally, MRI scanning may be useful in the planning of synovectomies by determining the extent of synovitis within the joint.
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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,
Complications Of Untreated Lyme Disease
If unchecked, the Lyme disease infection can spread to other bodily systems, causing significant damage. Untreated, complications of this condition can be very severe:
- Arthritis:Prolonged infection with Lyme disease leads to chronic joint inflammation and swelling, usually in the knees . These symptoms tend to arise within two years of infection, with periods of flare-ups and remissions. This arthritis is relatively difficult to manage, though antibiotics and steroids may be attempted.
- Lyme carditis:If the bacteria reach the heart tissues, they can cause inflammation and lead to heart block. The electrical signals being sent between the upper and lower chambers of the heart are interrupted, impairing the coordination of the heartbeat. Though disruptive, this is rarely fatal.
- Lyme neuroborreliosis:Inflammation of multiple nerves, including those in the spine and brain, is the chief characteristic of this condition. This can also affect the meningesthe layer of tissue surrounding the brain and spineleading to meningitis, among other conditions. Antibiotic therapy, if applied promptly, tends to be effective as a treatment.
Even in cases where Lyme disease has progressed, antibiotic regimensespecially drugs like doxycyclineare generally successful in resolving problems.
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What Is Lyme Disease
Lyme disease is a bacterial infection. You get it when the blacklegged tick, also known as a deer tick, bites you and stays attached for 36 to 48 hours. If you remove the tick within 48 hours, you probably wonât get infected.
When you do get infected, the bacteria travel through your bloodstream and affect various tissues in your body. If you donât treat Lyme disease early on, it can turn into an inflammatory condition that affects multiple systems, starting with your skin, joints, and nervous system and moving to organs later on.
The chances you might get Lyme disease from a tick bite depend on the kind of tick, where you were when it bit you, and how long the tick was attached to you. Youâre most likely to get Lyme disease if you live in the Northeastern United States. The upper Midwest is also a hot spot. But the disease now affects people in all 50 states and the District of Columbia.