Lyme arthritis (joint Lyme disease) is one of the forms of Lyme disease. Symptoms of Lyme arthritis, such as joint pain or stiffness, may not appear until several months or even several years after infection, so patients often do not associate them with a tick bite. And the longer the disease is not diagnosed, the more difficult the treatment.

Lyme arthritis (joint Lyme disease) is one of the forms of Lyme disease. Lyme disease is a chronic, multi-system inflammatory disease caused by the spirochetes of the Borrelia species.

One of the common symptoms of Lyme disease is bone and joint system involvement. It can also take the cutaneous (so-called erythema migrans), neurological or cardiological forms. In Europe, arthritis in patients with Lyme disease is rare (in 3-15% of patients).

Contents:

  1. Lyme arthritis - causes
  2. Lyme arthritis - symptoms of the acute form of the disease
  3. Lyme arthritis - symptoms of the chronic form of the disease
  4. Lyme arthritis - diagnosis
  5. Lyme arthritis treatment

Lyme arthritis - causes

The disease is caused by Borrelia burgdorferi bacteria, transmitted by ticks of the genus Ixodes. In the initial period, the bacteria Borrelia burgdorferi penetrate through the blood into the synovial fluid and into the synovial membrane of the joints.

Lyme arthritis - symptoms of the acute form of the disease

In the course of Lyme disease, symptoms of the musculoskeletal system may occur at any stage of the disease.

At the very beginning of the disease, there may be temporary joint pain,usually of low intensity, as a symptom accompanying migratory erythema. They usually resolve spontaneously and are not related to the later onset of arthritis.

Articular Lyme disease manifests as recurrent, brief episodes of swelling and pain in one or, more rarely, two joints, usually lasting several weeks. The changes are usually asymmetrical and not verylesne.

Joint symptoms most often occur during the period of disseminated infection, which lasts from a few days to 10-12 months. During this period, patients report bone and joint pain andmuscles and around the tendons and tendon attachments, which are:

  • wandering(difficult to determine its location)
  • they are usually short-lived(from a few hours to several days), but their recurrent nature gives a feeling of sickness and fatigue
  • has a tendency to relapse and the variable

Joint involvement appears on average within 6 months (from 2 weeks to 2 years) after the first symptoms, according to different authors, they occur in about 20-60 percent. untreated patients and takes the form of brief, recurring episodes of pain and swelling, usually in one, or more rarely, several joints.

These ailments are often asymmetric, not too severe, most often affecting the joints of the limbs. After a few weeks, they may resolve spontaneously or develop into full-blown acute arthritis.

Acute arthritis is one of the more common symptoms of Lyme disease - it affects approx. 50-60 percent of people. untreated patients and about 30 percent. treated. It appears:

  • pain, swelling, sometimes a lot of exudate in the joint
  • warming, but usually without a marked reddening of the joint area
  • sometimes there is a feeling of fatigue, rarely a slight morning stiffness
  • arthritis can last from days to weeks, and sometimes even months
  • the most common inflammatory process is one joint, less often 2-3 joints
  • the most common complaints concern the knee joints (63%), less often the ankles, shoulder and elbow joints, temporomandibular joints and hand joints. There are also cases with hip involvement
  • in the case of involvement of the knee joints, Baker's cysts may also develop, which tend to rupture
  • in the periods between exacerbations the patients may not report any complaints from the musculoskeletal system

Subsequent relapses are usually less intense.

Lyme arthritis - symptoms of the chronic form of the disease

U about 10 percent In patients who have not been treated with antibiotics before, arthritis turns into a chronic form, which may have the character of polyarthritis.Chronic arthritis can be diagnosed when symptoms of arthritis in the same localization persist for at least a year.It most often affects the knee joints.

May lead to the development of destructive changes in the joint, but only occasionally changes lead to permanent damage and immobilization of the joint. Chronic arthritis very rarely takes the form of stenotic polyarthritisjoint spaces and the presence of erosions, mimicking rheumatoid arthritis.

Worth knowing

Symptoms of the musculoskeletal system may appear at different times from the onset of infection, after several days or even years.

Symptoms can take various forms - from short-term, transient, minor pain in the musculoskeletal system, through symptoms of acute exuding arthritis, to rare forms of chronic arthritis with osteoarticular destruction ( about 10% of cases).

Tendinitis is less frequently observed in the course of Lyme disease(tendinitis), dactylitis, myositis, and subacute osteomyelitis

Lyme arthritis - diagnosis

The diagnosis of the articular form of Lyme disease is based on a correctly collected history, physical examination and additional tests consisting in the detection of antibodies in the patient's blood serum against the surface proteins of B. burgdorferii spirochetes.

For this purpose, the enzymatic immobilization test (ELISA) is used, which, due to the risk of false positive results, must be confirmed by Western blot method. The most accurate method is the polymerase chain reaction (PCR).

Lyme disease is a multi-organ disease, joint symptoms are only one of the symptoms

Lyme arthritis treatment

According to the recommendations of the IDSA (Infectious Diseases Society of America), the articular form of the disease can be successfully treated with oral antibiotic therapy.Arthritisand other musculoskeletal symptoms disappear completely in most patients under the influence of antibiotics for 2-4 weeks. According to the current recommendations, antibiotic therapy in Lyme disease should not be repeated more often than 2-3 times.

The first flare of arthritis, according to the recommendations in force in Poland, should be treated with an antibiotic used orally for 14-28 days, while in recurrent arthritis, intravenous antibiotic therapy is also recommended for 14-28 days.

For antibiotic-resistant chronic Lyme arthritis, symptomatic treatment is used- non-steroidal anti-inflammatory drugs, disease-modifying drugs (hydroxychloroquine) and intra-articular glucocorticoid injections.

If chronic arthritis persists for more than 12 months, an arthroscopic synovectomy (surgical operation to remove the affected area) is recommended.the synovial membrane within a joint or tendon).

Bibliography:

1. Parada-Turska J., Articular form of Lyme disease - clinical picture and treatment, "Rheumatology" 2013

2. Lyme arthritis, Rydz-Stryszowska I., Batko B., Krawiec P., Krzanowski M., Jurek Krawiec M., Skura A., "Przegląd Lekarski" 2007

Category:

Research