Related Experiment Videos
Musculoskeletal manifestations of Lyme disease
1Division of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
Abstract:
Musculoskeletal involvement, particularly arthritis, is a common feature of Lyme disease. Early in the illness, patients may experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone in one or a few locations at a time, frequently lasting only hours or days in a given location. Weeks to months later, after the development of a marked cellular and humoral immune response to the spirochete, untreated patients often have intermittent or chronic monoarticular or oligoarticular arthritis-primarily in large joints, especially the knee-during a period of several years. The diagnosis of Lyme arthritis is usually based on the presence of this characteristic clinical picture, exposure in an endemic area, and an elevated immunoglobulin G antibody response to Borrelia burgdorferi. In addition, spirochetal DNA can often be detected in joint fluid by polymerase chain reaction. Lyme arthritis can usually be treated successfully with 1-month courses of oral doxycycline or amoxicillin or with 2- to 4-week courses of intravenous ceftriaxone. However, patients with certain genetic and immune markers may have persistent arthritis, despite treatment with oral or intravenous antibiotics. B. burgdorferi may occasionally trigger fibromyalgia, a chronic pain syndrome with diffuse joint and muscle symptoms. This syndrome does not appear to respond to antibiotic therapy.
Insights
Lyme disease commonly causes arthritis, often affecting large joints like the knee. While typically treatable with antibiotics, some patients experience persistent Lyme arthritis due to genetic factors.
Area of Science:
- Infectious Diseases
- Rheumatology
- Immunology
Background:
- Lyme disease, caused by Borrelia burgdorferi, frequently manifests with musculoskeletal symptoms, including migratory pain and persistent arthritis.
- Lyme arthritis typically presents as monoarticular or oligoarticular inflammation, predominantly in large joints, and can last for years in untreated individuals.
Purpose of the Study:
- To summarize the clinical presentation, diagnosis, and treatment of Lyme arthritis.
- To discuss potential factors contributing to persistent arthritis despite antibiotic therapy.
Main Methods:
- Diagnosis relies on clinical presentation, exposure history, serological evidence of Borrelia burgdorferi infection (elevated IgG antibodies), and detection of spirochetal DNA via PCR in synovial fluid.
- Treatment involves oral antibiotics (doxycycline, amoxicillin) or intravenous antibiotics (ceftriaxone).
Main Results:
- Lyme arthritis is characterized by migratory pain followed by intermittent or chronic joint inflammation, primarily in the knee.
- Successful treatment is usually achieved with standard antibiotic courses, but persistent arthritis can occur in a subset of patients.
- Borrelia burgdorferi may also trigger fibromyalgia, a distinct chronic pain syndrome unresponsive to antibiotics.
Conclusions:
- Lyme arthritis is a common manifestation of Lyme disease, diagnosable through clinical and laboratory findings.
- While generally responsive to antibiotics, persistent Lyme arthritis warrants further investigation into host factors.
- Fibromyalgia is a potential sequela of Borrelia burgdorferi infection, requiring different management strategies.