The Rheumatologist
COVID-19 News
  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed
  • Home
  • Conditions
    • Rheumatoid Arthritis
    • SLE (Lupus)
    • Crystal Arthritis
      • Gout Resource Center
    • Spondyloarthritis
    • Osteoarthritis
    • Soft Tissue Pain
    • Scleroderma
    • Vasculitis
    • Systemic Inflammatory Syndromes
    • Guidelines
  • Resource Centers
    • Ankylosing Spondylitis Resource Center
    • Gout Resource Center
    • Psoriatic Arthritis Resource Center
    • Rheumatoid Arthritis Resource Center
    • Systemic Lupus Erythematosus Resource Center
  • Drug Updates
    • Biologics & Biosimilars
    • DMARDs & Immunosuppressives
    • Topical Drugs
    • Analgesics
    • Safety
    • Pharma Co. News
  • Professional Topics
    • Ethics
    • Legal
    • Legislation & Advocacy
    • Career Development
      • Certification
      • Education & Training
    • Awards
    • Profiles
    • President’s Perspective
    • Rheuminations
    • Workforce
  • Practice Management
    • Billing/Coding
    • Quality Assurance/Improvement
    • Workforce
    • Facility
    • Patient Perspective
    • Electronic Health Records
    • Apps
    • Information Technology
    • From the College
    • Multimedia
      • Audio
      • Video
  • Resources
    • Issue Archives
    • ACR Convergence
      • Systemic Lupus Erythematosus Resource Center
      • Rheumatoid Arthritis Resource Center
      • Gout Resource Center
      • Abstracts
      • Meeting Reports
      • ACR Convergence Home
    • American College of Rheumatology
    • ACR ExamRheum
    • Research Reviews
    • ACR Journals
      • Arthritis & Rheumatology
      • Arthritis Care & Research
      • ACR Open Rheumatology
    • Rheumatology Image Library
    • Treatment Guidelines
    • Rheumatology Research Foundation
    • Events
  • About Us
    • Mission/Vision
    • Meet the Authors
    • Meet the Editors
    • Contribute to The Rheumatologist
    • Subscription
    • Contact
  • Advertise
  • Search
You are here: Home / Articles / Lyme Arthritis: Presentation, Diagnosis & Treatment

Lyme Arthritis: Presentation, Diagnosis & Treatment

July 18, 2019 • By John N. Aucott, MD, & Sheila L. Arvikar, MD

  • Tweet
  • Email
Print-Friendly Version / Save PDF

A 52-year-old man living in greater Boston with a history of hyper­tension presented at our rheumatology clinic with bilateral knee pain and swelling. He had been in his usual state of health until four months earlier when he developed right knee pain and swelling without an incipient trauma, which did not improve with non-steroidal anti-inflammatory drugs (NSAIDs). His primary care physician ordered imaging: X-rays showed a moderate effusion, and magnetic resonance imaging (MRI) showed meniscal tears and a Baker’s cyst (see photos 1 and 2). He was referred to an orthopedist, but his symptoms spontaneously resolved.

You Might Also Like
  • Diagnosis, Treatment Updates for Lyme Arthritis
  • Lyme Arthritis Treatment Protocols Critical as Lyme Disease Spreads
  • Septic or Lyme Hip Arthritis? Rapid Lyme Diagnostics Could Avoid Unnecessary Treatment
Explore This Issue
July 2019

One month ago, his left knee became swollen and painful.

ad goes here:advert-1
ADVERTISEMENT
SCROLL TO CONTINUE

The patient did not recall any flu-like illness, bull’s-eye rash or specific tick exposure. He had traveled to Cape Cod in the summer of the previous year and done some hiking there.

His primary care physician ordered Lyme antibody testing. Both the ELISA (enzyme-linked immunosorbent assay) and Western blot with 9 IgG bands and 2 IgM bands were strongly positive for Lyme disease.

Photo 1: An X-ray of the right knee reveals a moderate-sized effusion.

Photo 1: An X-ray of the right knee reveals a moderate-sized effusion.

The patient was treated with a one-month course of 100 mg of doxycycline by mouth twice daily. However, he did not significantly improve and was referred to our rheumatology clinic. At his initial rheumatology visit, he complained of persistent bilateral knee discomfort and stiffness. He was unable to bike or walk for exercise.

On examination, we found he had a moderate right knee effusion with a suprapatellar component, mild warmth, and pain on extension and flexion. He also had a significant, left popliteal fullness with a smaller suprapatellar effusion and warmth.

Aspiration of the right knee was inflammatory with 22,180 white blood cells, 65% neutrophils. Crystal analysis, gram stain and culture tests were all negative. Laboratory studies showed systemic inflammation with an erythrocyte sedimentation rate (ESR) of 38 mm/hr and a C-reactive protein (CRP) level of 36.4 mg/L.

ad goes here:advert-3
ADVERTISEMENT
SCROLL TO CONTINUE

Discussion

Lyme disease, a tick-borne infection with the spirochete Borrelia burgdorferi, is epidemic in areas of the U.S., particularly on the East Coast and in the upper Midwest, and is spreading into new geographic areas.1 Lyme disease occurs in phases, starting with the erythema migrans skin lesion. With dissemination, cardiac, neurologic and arthritic manifestations may develop. Musculoskeletal symptoms are present in all phases of Lyme disease, with arthralgias and myalgias often accompanying erythema migrans.

Frank arthritis is a late disease manifestation, developing in approximately 60% of untreated patients, a mean of six months and up to two years following erythema migrans.2 Lyme arthritis is the most common late manifestation of Lyme disease in the U.S. and accounts for one-third of the cases reported to the Centers for Disease Control & Prevention (CDC).1 Given the rising burden of Lyme disease, it is likely that Lyme arthritis will be an ongoing concern for physicians, particularly rheumatologists and orthopedists.

Lyme arthritis is an oligoarthritis most commonly affecting the knees. Other joints, such as the ankle, shoulder, elbow or wrist, may be involved. The arthritis may be migratory or intermittent, particularly initially, as well as persistent. Lyme arthritis is almost never a symmetric polyarthritis involving small joints.

Pages: 1 2 3 4 5 | Single Page

Filed Under: Conditions Tagged With: Borrelia burgdorferi, Lyme arthritis, Lyme DiseaseIssue: July 2019

You Might Also Like:
  • Diagnosis, Treatment Updates for Lyme Arthritis
  • Lyme Arthritis Treatment Protocols Critical as Lyme Disease Spreads
  • Septic or Lyme Hip Arthritis? Rapid Lyme Diagnostics Could Avoid Unnecessary Treatment
  • Letters: Detecting Lyme Disease May Require Thorough Testing

ACR Convergence

Don’t miss rheumatology’s premier scientific meeting for anyone involved in research or the delivery of rheumatologic care or services.

Visit the ACR Convergence site »

Rheumatology Research Foundation

The Foundation is the largest private funding source for rheumatology research and training in the U.S.

Learn more »

American College of Rheumatology

Visit the official website for the American College of Rheumatology.

Visit the ACR »

The Rheumatologist newsmagazine reports on issues and trends in the management and treatment of rheumatic diseases. The Rheumatologist reaches 11,500 rheumatologists, internists, orthopedic surgeons, nurse practitioners, physician assistants, nurses, and other healthcare professionals who practice, research, or teach in the field of rheumatology.

About Us / Contact Us / Advertise / Privacy Policy / Terms of Use

  • Connect with us:
  • Facebook
  • Twitter
  • LinkedIn
  • YouTube
  • Feed

Copyright © 2006–2021 American College of Rheumatology. All rights reserved.

ISSN 1931-3268 (print)
ISSN 1931-3209 (online)

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.