Differential Diagnosis

lyme disease diagnosis cartoon

Copyright - TJI Sipress - Differential diagnosis of Lyme disease can be costly in many ways

Diagnosing Lyme disease is exceedingly tricky and there are many conditions which provide a differential diagnosis for Lyme disease. Amongst these are lupus, rheumatoid arthritis, gout, osteoarthritis, and even neurological problems such as Alzheimer’s Disease, Schizophrenia, and Multiple Sclerosis. Lyme disease has been called the ‘great mimic’ with a variety of symptoms, spread over a long period of time, and seemingly unconnected to each other.

Many patients do not realize that their symptoms are related to a single illness and it is possible that a patient with joint pain and the occasional flu-like illness simply considers themselves to be getting old and creaky and suffering from a few more colds than previously. Seeking out medical advice might be limited to cases where symptoms become particularly debilitating or worrying, such as where mobility is affected, cognitive deficits arise, or where a patient has persistent low energy or extreme fatigue.


Is it Really Lyme Disease?

It is important to remember that a differential diagnosis also exists for Lyme disease, with a small number of patients diagnosed with the infection despite inconclusive test results and myriad symptoms. Patients with a condition such as Multiple Sclerosis may be misdiagnosed with Lyme disease and have appropriate treatment delayed until permanent neurological damage has occurred. Early intervention in such illnesses has been shown to significantly affect the outcome of a patient’s condition, making misdiagnosis extremely damaging.

Clearly, most doctors will not intentionally delay treatment or use a ‘catch-all’ diagnosis of Lyme disease for patients without exhausting all other options, but there are some unscrupulous physicians (or those pretending to be Lyme disease doctors) who peddle miracle cures for Lyme only to harm patients with a different condition. Some patients have gone for years being treated by quack practitioners for illnesses, such as suspected MS, AIDS, or Lyme disease with little, or no, evidence of them ever having had such conditions. Prosecutions have occurred in some cases.


Diagnosing Lyme Disease Accurately

All doctors need to review a patient’s symptoms, medical history, and test results whilst keeping a number of diagnoses in mind. In a state where Lyme disease remains relatively rare, this differential diagnosis may not be the first thing that a doctor thinks of when confronted with the variety of symptoms the infection presents, especially if classic signs, such as the Lyme disease rash, are absent. Conducting appropriate tests, such as X-Rays, MRI scans, blood tests, and even tests of synovial fluid from joints or cerebrospinal fluid to rule out conditions such as meningitis may be necessary to narrow down the diagnosis of Lyme disease.

What if I have Lyme and Fibromyalgia?

A differential diagnosis is not the end of the story for Lyme disease however, as patients are clearly susceptible to more than one illness at a time and could have fibromyalgia, depression, and Lyme disease, for example. In tragic cases, patients are misdiagnosed and given medications that are downright harmful for the illness they actually have. This is the case with those patients who have Lyme disease but are diagnosed with a condition such as arthritis and given steroid treatment. As steroids suppress the immune system, the body becomes even less able to defend itself against infection and the likelihood of long-term Lyme disease complications is increased. Real skill is required on the doctors’ part when connecting patients’ varied symptoms, even if these symptoms are separated by several months, or even years. More accurate reports of the incidence and effects of the illness would better help physicians assess the relative risk of Borrelial infection compared to other conditions providing a differential diagnosis of Lyme disease.

Continue Reading –> Lyme Disease and Lupus