Lyme Arthritis: Occurrence, Diagnosis, Treatment, Prevention
What is Lyme Arthritis?
Lyme arthritis is a symptom of Lyme disease that is named after ‘Old Lyme’- a city in Connecticut, USA. It occurs due to a bacterial infection caused by the ‘Borrelia’ species of bacteria. Lyme arthritis or the main Lyme disease spreads through infected ticks, found in mammals. When these infected ticks come in contact with humans, in any form of their developmental stage, they cause Lyme disease in humans.
Lyme arthritis is seen in Lyme disease, which affects the large joints and is seen after a prolonged period of untreated Lyme disease. However, although a patient presenting with arthritis has a history of Lyme disease, it doesn’t always mean it is Lyme arthritis. Recent studies have proved that following Lyme disease the patient can develop systemic arthritis- caused by autoimmune conditions namely rheumatoid or psoriatic arthritis. This is common among the older population who have an additional positive family history of autoimmune disorders. Autoimmune arthritis differs from Lyme Arthritis by being comparatively universal- affecting all joints while the effects of Lyme arthritis is generally bound to large joints, primarily the knee joint.
Lyme arthritis occurs in Lyme disease in the majority of the affected who aren’t treated for the primary infection. Some patients require further treatment with anti-inflammatories when this particular symptom doesn’t respond to the antibiotics.
Occurrence of Lyme Arthritis
The occurrence of Lyme arthritis can be seen in the following ways.
- An active infection that responds to antibiotics used to treat the primary infection- that leaves no need for further anti-inflammatory medication.
- A post infectious condition where all other symptoms respond to antibiotics except arthritis which is treated using the anti-inflammatories.
- The occurrence of Lyme arthritis can also be a secondary response that occurs following the complete treatment of the Lyme arthritis- either by antibiotics or anti-inflammatories. This can take a few years to emerge and is systemic arthritis. Only the past history indicates that there’s an association with Lyme disease- this secondary arthritis is an autoimmune response to the previous infection of Lyme disease. This response is triggered by factors such as a family history of the autoimmune disease, among people who are older and overweight.
Other joints that may be affected by Lyme arthritis are the shoulder joints, ankle joints, and the elbow joints.
Diagnosis of Lyme Arthritis
The diagnosis of Lyme arthritis is mainly based on the clinical symptoms and the involvement of joint. Multiple joint arthritis usually points away from Lyme arthritis- an important diagnostic character.
- Other indicators such as psoriasis of skin, blood tests showing rheumatoid factors are all relevant in the differential diagnosis. Relevant history of travel, other autoimmune conditions are necessary.
- Other confirmatory tests that aid in diagnosis of Lyme arthritis are blood tests for Lyme antibodies. The titers are generally very high in case of late stage infection.
- Early diagnosis using antibody test results in many false negative results- hence in this stage it’s better to watch out for the symptoms.
However, the later stages of the disease provide accurate results and these are very relevant.
Immunofluorescence-ELISA-Enzyme-Linked Immunosorbent Assay - This test is done to detect relevant antibodies. But it’s not reliable as many diseases such as infectious mononucleosis, systemic ‘lupus’ erythematosus, etc. can indicate false positive results for the same. These are known more commonly as two tier-tests.
Western Blotting test- For confirmed diagnosis, Western Blot test is to be done though it is expensive and demanding but offers accuracy. This test is done by using principles of centrifugation in order to determine the presence of antibodies based on antigen-antibody reactions. If the bands of colors are present in predestined locations then the disease can be confirmed.
Polymer Chain Reaction- PCR is done by duplicating the DNA samples to increase the quantity thus making detection for the presence of the bacteria easier.
Microscopic examination of the blood, urine, cerebro-spinal fluid (CSF) are also done to detect the presence of the causative bacteria- the antigens. Antibodies are substances produced by the body’s immune system as a response to antigens.
Treatment of Lyme Arthritis
Studies have indicated that treatment of Lyme arthritis should be done only in case of positive tests that are not accompanied by any symptoms in the patient. However, upon noticing the first most important sign of disease- the bull’s eye rash, therapy is always provided to stop the progression of the Lyme disease further.
The standard regimen for treatment of Lyme arthritis is a two-week course of 200 mg Doxycycline every day or a 500 mg course of Amoxicillin three times a day. Early stages may have reactions to therapy in the form of an uncommon condition known as Jarisch-Herxheimer Reaction that occurs during the first day of the therapy, if at all. It’s a manageable Reaction that disappears in 24 hours and is characterized by a headache, fever, body pain and weakness.
In case of pregnant women and those patients who are allergic to doxycycline and amoxicillin, a two-week treatment with either cefuroxime axetil or erythromycin is indicated.
The above treatments are applicable for the early stages of the disease. The disseminated stage and arthritis need to be treated for 4 weeks. The poor response to arthritis shall require anti-inflammatory medications and corticosteroids.
Prevention of Lyme Arthritis
Prevention of Lyme arthritis mainly focuses on prevention and proper management of tick bites. In areas prone to tick bites, covered and protective clothing must be worn.
In case of tick bite, removing the insect immediately proves helpful as it generally takes a few hours of blood feeding for the bacteria to be transmitted to humans but this may be possible only in case of adult ticks that are visible easily.