Introduction
Lyme disease is a bacterial infection that is caused by the bite of an infected tick. The bacteria that causes this disease is referred to as Borrelia burgdorferi. The disease's initial stage is characterized by a red ring-like lesion at the site of tick bites called Erythema migrans. There are various stages of this disease, with most patients only experiencing the symptoms of the early stages. Some of the symptoms include fever, malaise, fatigue, and headache. Rheumatic symptoms are not seen until the disease has advanced to its later stages. About 60 percent of people affected have been reported to suffer from Lyme arthritis, which involves inflammation of the joints and muscle pain, indicating their severity.
What Is Lyme Arthritis?
When Lyme disease does not receive prompt antibiotic treatment, it can progress to later stages characterized by joint aches and muscle pains. Hence, Lyme arthritis is also referred to as late Lyme disease arthritis. The prime cause of this type of arthritis is the invasion of the tick bacteria into the bone and the joints. The joint site is found to be inflamed, complemented with muscle pain. The knee joint is most commonly affected, secondary to other joint locations: shoulder, ankles, elbows, and wrists.
What Are the Symptoms of Lyme Arthritis?
The symptoms experienced in early Lyme stages are generalized and resemble the flu-like symptoms observed during a common cold. As there occurs a shift from early to late Lyme stage—due to improper or lack of treatment—the symptoms of arthritis overpower the early Lyme symptoms. The arthritic symptoms appear one to 1.5 months after the tick bite infection.
Symptoms include:
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Joint Pain: This is persistent, sometimes severe, pain is observed in one or more joints, mostly in the knees, but it can also affect other joints such as the hips, shoulders, elbows, or ankles.
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Joint Swelling: Swelling and inflammation in the affected joints leading to stiffness and limited range of motion.
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Redness and Warmth: The impacted joints might exude warmth upon touch and exhibit a reddened or inflamed appearance on the skin.
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Recurrent Episodes: Lyme arthritis can cause recurrent and short episodes of joint swelling and pain, which may occur over time.
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Fatigue: Some individuals with Lyme arthritis may experience fatigue, which can be mild to severe and may interfere with daily activities.
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Fever: In some cases, individuals with Lyme arthritis may develop a low-grade fever, which may persist for days.
How Is Lyme Arthritis Diagnosed?
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Clinical Picture of the Affected Arthritic Joint: When a skilled orthopedist or rheumatologist assesses the joint clinically, he or she can determine the cause of the joint changes and order appropriate diagnostic tests to confirm the diagnosis.
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Serological Testing: Serum samples are acquired and tested for antibodies to Borrelia burgdorferi, the bacteria responsible for Lyme disease. The ELISA and Western Blotting tests are performed simultaneously to confirm the diagnosis in potential patients.
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PCR Testing: Synovial fluid in the joint is aspirated to perform a polymerised chain reaction (PCR) testing for the presence of B.burgdorferi DNA. However, this testing is generally not preferred and only serves as an alternate test to confirm the diagnosis.
How Often Is Lyme Misdiagnosed as Rheumatoid Arthritis?
A patient with a reliable tick bite history can confirm the Lyme disease diagnosis. Besides that, some telltale signs help differentiate the diagnosis of Lyme arthritis from other types.
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Lyme arthritis is rarely found to be symmetrical in both joints of a pair. Unlike rheumatoid arthritis, only the joint invaded by the bacteria is a victim of Lyme arthritis.
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The joint's range of motion affected by Lyme arthritis is not too bad and can be enhanced passively (an external force causing joint movement).
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Although the sight of an arthritic joint due to Lyme disease may look serious at a glance, the level of pain is very minimal and inconsistent.
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Lyme arthritis may only affect one or more joints of the body. Large joints like knees and ankles are the most prone to this infection.
How to Treat Lyme Arthritis?
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The first line of treatment for any bacterial infection is administration of antibiotics. The Lyme disease leading to Lyme arthritis is also resolved by following a strict four-week course regimen of antibiotics. After completing the first course, there is a chance of minimal improvement in joint health. In such cases, the patient is followed up with a second course of antibiotics. Pain and swelling at the joint site often persist or may recur even after two courses of antibiotics.
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In such circumstances, administering an additional dosage of antibiotics via an IV route may be opted for. Disease-modifying antirheumatic drugs (DMARDs) are prescribed for joint infections that are too stubborn to resolve after two months of strict antibiotic therapy.
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Occasionally, doctors may recommend corticosteroids like Prednisone to diminish inflammation and relieve symptoms. However, due to potential side effects, corticosteroids are generally used sparingly and are usually reserved for cases where NSAIDs are not sufficient.
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Over-the-counter painkillers (like Ibuprofen) can be administered for severe, unbearable bouts of pain. Rarely surgical intervention is required to treat Lyme arthritis.
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Physical therapy can be beneficial in restoring joint function and mobility, especially after the acute phase of Lyme arthritis has resolved. A physical therapist can suggest exercises and methodologies to bolster muscles, improve flexibility, and reduce pain.
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Refraining from strenuous activities exacerbating symptoms and giving the affected joint ample rest can help prevent further damage and promote healing. Supportive devices such as braces or splints may also be recommended to stabilize the joint and reduce strain.
Conclusion
Late-stage Lyme arthritis can be easily avoided if timely and accurate antibiotic therapy is administered during the early stage of Lyme disease. In addition to timely antibiotic therapy during the early stages of Lyme disease, individuals must take proactive measures to prevent tick bites in endemic areas. Although completely reversible (with antibiotic therapy), untreated Lyme arthritis has the potential to cause permanent damage to the infected joint. One can prevent oneself from Lyme by wearing long-sleeved clothes and pants in a tick-prone area. Referral to a rheumatologist becomes evident in cases showing no improvement despite drug therapy.
