Lyme Arthritis

What is Lyme arthritis?

Lyme arthritis is caused by Lyme disease, a deer tick-transmitted infection caused by the spirochete Borrelia burgdorferi. If left undiagnosed or untreated, the infection may spread to the joints, heart, and nervous system, causing serious complications. As the condition progresses, arthritis may develop and cause recurrent swelling of one or more joints.

In some children, the first or only symptom of Lyme disease is joint pain and swelling. In these cases, it can be challenging to distinguish between Lyme arthritis and juvenile arthritis. Physicians at our Pediatric Rheumatology Program have extensive experience with the diagnosis and treatment of all types of joint pain and arthritis.

What are the symptoms of Lyme arthritis?

Lyme arthritis usually occurs during a later stage of Lyme disease that has not been treated. For many children, arthritis is the first symptom of Lyme disease they experience, and most do not remember being bitten by a tick.

Symptoms of Lyme arthritis include:

• Joint pain, usually in the knees
• Joint swelling, usually in the knees
• Limping or inability to put weight on a limb

Early symptoms of Lyme disease may include:

• Enlarging, warm rash at the site of the bite that can last days to weeks, often with a partial central clearing so that it looks like a “bull’s eye” 
• Fever
• Headache
• Fatigue
• Chills
• Swollen lymph nodes

If left untreated, later stage symptoms of Lyme disease can include:

• Rash on other parts of the body
• Bell’s palsy (paralysis on one or both sides of the face)
• Severe headache and neck stiffness (meningitis)
• Pain and swelling in the large joints
• Heart palpitations

How is Lyme arthritis diagnosed?

When Lyme disease is suspected as the cause of your child’s arthritis, it’s important to be diagnosed by a pediatric rheumatologist who can distinguish Lyme arthritis from juvenile arthritis. Your physician will conduct a full medical exam and may ask questions about where and when your child may have been exposed to ticks. To diagnose Lyme disease, your physician will order blood tests.

There are two blood tests to diagnose Lyme disease:

• Enzyme-linked immunosorbent assay (ELISA) test. The test detects antibodies to B. burgdorferi. False-positive results are not uncommon, so it is used in conjunction with the Western blot test if results are positive.
• Western blot test. If the ELISA test is positive, this test can help confirm the diagnosis. In this two-step approach, the Western blot detects antibodies to several proteins of B. burgdorferi.

How is Lyme arthritis treated?

Most children with Lyme arthritis recover after 28 days of antibiotic treatment. The most common antibiotics prescribed for Lyme disease are:

• Doxycycline for children eight years of age or older
• Amoxicillin for children under eight years of age

If the symptoms persist after a course of antibiotics, a second course of antibiotics may be prescribed.

In persistent cases of Lyme arthritis, your rheumatologist may prescribe non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), or intra-articular corticosteroids.

Prevention of Lyme arthritis

Preventive measures to avoid or minimize tick bites are important and may include landscaping measures, removal of deer from specific areas, wearing appropriate clothing such as pants tucked into socks, and tick repellants. In areas where ticks are common, it’s important to check your child frequently and remove any ticks. Ticks may remain on your child’s skin for hours before attaching themselves, so checking for ticks after coming inside may help remove them before they attach.