Exacerbation of Osteoarthritic Joint Pain by Lyme Disease

Lyme disease progresses through three distinct clinical phases: early localized, early disseminated, and late disseminated. Lyme arthritis is characterized by attacks of joint swelling lasting for weeks to months, potentially causing permanent joint damage in late disseminated disease. Our case focuses on a 63-year-old, obese, type 2 diabetic, wheelchair-bound, Caucasian male with severe bilateral knee pain. Our patient had previously undergone bilateral knee arthroscopies for meniscal tears and also had knee injections performed previously without the desired level of pain alleviation. He indicated a recent cough that was treated with erythromycin and noted his knees felt better during the course of the antibiotic. The patient recreationally enjoyed hunting and mentioned that his dog had Lyme Disease. Laboratory confirmation of Lyme disease prompted our patient to be treated with doxycycline. Upon completion of doxycycline therapy, our patient noted significant improvement in his knee pain. The improvement was significant enough that the patient canceled a planned bilateral knee replacement with his orthopedic surgeon, and no longer required the use of a wheelchair as he was able to return to ambulating independently. The patient's quality of life improved significantly, and he could also return to work. Lyme disease should be a consideration in the differential diagnosis of patients in areas endemic to the disease, and patients who tend to have outdoor lifestyles.