Lyme Disease Arthritis
An estimated 60% of patients with Lyme disease have symptoms of joint pain which comes and goes and affects multiple body parts. Lyme disease arthritis is more common in North America than in Europe where cognitive symptoms of Lyme disease (neuroborreliosis) are more frequently observed. Although Lyme disease, Rheumatoid arthritis, and osteoarthritis may share similar symptoms, it is usually possible, through careful examination to differentiate them. Lyme disease arthritis episodes generally last for between a week and three months and usually affect the larger joints such as the knees, although the temporomandibular (jaw) joint is also a common site of Lyme disease arthritis pain. Patients with untreated Lyme disease have a higher incidence of Lyme arthritis, with around 80% experiencing painful joints within two years of infection.
When Lyme Arthritis Occurs
Most patients (around two thirds) who develop Lyme arthritis do so within six months of an initial erythema migrans Lyme disease rash. The inflammation of the joints usually evolves over a couple of days as a migratory pain affecting the tendons, joint capsule, and joint fluid in a number of different joints before concentrating in one or two joints in most cases. This progression from a migratory polyarticular process to a monoarticular process does not always occur however, with some patients continuing to have intermittent transient joint pain affecting numerous parts of the body. Two thirds of patients experience three recurrent week-long episodes of joint pain with about two and a half months in between. Such recurrences diminish over time however, with untreated patients not usually experiencing Lyme arthritis after a ten year period.
Diagnosing Lyme Arthritis
The severity of the condition varies, with some patients experiencing joint pain without any objective findings, others showing clear signs of arthritis on physical assessment and with diagnostic imaging, and some developing a chronic erosive synovitis where the fluid in the joints, and the joint capsule is irrevocably damaged. The joints affected may feel warm to the touch, are usually swollen, and painful, but are not generally red as with joints that are septic. Most patients do not go on to develop permanent damage to the bone or cartilage, with less than 10% developing pannus (the growth of fibrovascular tissue) or tissue erosion in the joints. The incidence of Lyme disease arthritis was not well recognized in Europe until reports of the North American cases of Lyme arthritis emerged.
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