Tick-Borne Diseases in Orthopaedic Practice: Lyme Arthritis and Alpha-gal Syndrome

The prevalence of tick-borne disease continues to rise in the United States. Lyme disease is the most prevalent, classically presenting as monoarthralgia or polyarthralgia and effusions. Although most cases of Lyme arthritis are well managed with antibiotics, in some cases, refractory symptoms and arthritis persist. In addition, the tick-borne disease, alpha-gal syndrome (AGS), can have long-term sequelae, including immunoglobulin E-mediated hypersensitivity to mammalian products. Classically, AGS presents as a new onset of food allergy or intolerance to bovine products. As interest in biologics and xenografts for medical devices grows, AGS raises concerns about implant complications and perioperative anesthesia risks. It is imperative that the orthopaedic surgeon be aware of Lyme disease and AGS, and this review provides a concise overview of the pathogenesis, epidemiology, clinical presentation, diagnostic evaluation, and management of joint effusions as they pertain to tick-borne disease. We highlight the management pathway for AGS and tools for streamlining the preoperative pathway.