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RA Diagnosis Uses Lab Tests, Clinical Insight to Rule Out Lyme

Charles Radis, DO  |  Issue: August 2015  |  

In 2013, 95% of confirmed Lyme disease cases were reported from 14 states:

  • Connecticut
  • Delaware
  • Maine
  • Maryland
  • Massachusetts
  • Minnesota
  • New Hampshire
  • New Jersey
  • New York
  • Pennsylvania
  • Rhode Island
  • Vermont
  • Virginia
  • Wisconsin

Lyme disease is the most commonly reported vectorborne illness in the United States.

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In 2013, it was the fifth most common nationally notifiable disease. However, this disease does not occur nationwide and is concentrated heavily in the northeast and upper Midwest.

Source: Centers for Disease Control & Prevention, http://www.cdc.gov/lyme/stats/index.html

Diagnostic Clues

Rheumatologists need to use their senses—sight, sound, touch—to arrive at a diagnosis. Obtaining a complete history narrows the possible explanation for the patient’s symptoms. The distribution of tender or swollen joints also helps.

  • Lyme arthritis affects a single knee in 80% of cases.
  • Swelling of all three joints in a single finger or toe (giving the appearance of a sausage digit) is characteristic of psoriatic arthritis or ankylosing spondylitis.
  • The arthritis of Crohn’s disease—an immune system disorder affecting the bowel—primarily affects the large joints of the lower extremities, the knees and ankles.
  • Rheumatoid arthritis typically is symmetric and, early on, usually involves the small joints of the hands and feet.

References

  1. Rothschild BM, Woods RJ, Ortel W. Rheumatoid arthritis “In the buff”: Erosive arthritis in representative defleshed bones. Amer J Phys Anthropol. 1990 Aug;82(4):441–449.
  2. Landré-Beauvais AJ. The first description of rheumatoid arthritis. Unabridged text of the doctoral dissertation presented in 1800. Joint Bone Spine. 2001 Mar;68(2):130–143.
  3. Storey GD. Alfred Baring Garrod (1819–1907). Rheumatology. 40(10):1189–1190.
  4. Marquardt M. (1951) Paul Ehrlich. New York: Henry Schuman.
  5. Kallberg H, Ding Bo, Padyukov L, et al. Smoking is a major preventable risk factor for rheumatoid arthritis: Estimations of risk after various exposures to cigarette smoke. Ann Rheum Dis. 2011 Mar;70(3):508–511.

Editor’s note: For tips on dealing with difficult patients, see “How to Handle Conflict in Physician–Patient Relationships,” http://www.the-rheumatologist.org/article/how-to-handle-conflict-in-physician-patient-relationships.

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