Lyme Disease and Lupus

lupus rash common sites

Lupus and Lyme disease rashes are usually distinct

There are a number of illnesses that share similar characteristics, presenting problems for diagnosis and treatment.  Lyme disease, lupus, fibromyalgia, rheumatoid arthritis, chronic fatigue syndrome, multiple sclerosis, and even conditions such as schizophrenia, and bipolar disorder may be mistaken for each other in the course of diagnosing a patient’s condition.  Whilst the butterfly rash common in lupus patients is quite different from the bull’s-eye Lyme disease rash, there are other symptoms of lupus and Lyme that are similar.

Lupus, Lyme and Atrioventricular Block

One symptom of Lyme disease that may also occur in rheumatic fever, and in cases of neonatal lupus erythematosus, is atrioventricular block. Lyme disease and other inflammatory conditions, along with autoimmune conditions like lupus, can cause atrioventricular block which may be short-lived and resolve naturally or require intervention on a more permanent basis, such as having a pacemaker fitted. Atrioventricular block may be experienced as heart palpitations in a patient with Lyme disease or lupus, and establishing the cause is important so as to apply appropriate treatment.  Most patients with AV block due to Lyme disease have no long term heart complications provided that antibiotic treatment is successful in eradicating the infection and the condition usually resolves within a few days, or weeks. A temporary pacemaker may be needed during this time and the patient is usually monitored carefully to catch any escalation in symptoms early.



Lupus patients rarely present with atrioventricular block as an initial symptom and where it does occur it is often rapidly followed by serositis, and subsequent kidney problems and joint problems.  Arce-Salinas (et al, 2009) reports one such case of systemic lupus erythematosus in a 19yr-old woman who presented with seizures and a loss of consciousness, and who was diagnosed with complete atrioventricular block requiring a pacemaker.  Lyme disease patients may have a first-degree atrioventricular block which only becomes apparent following a standard ECG during diagnosis, whereas a third-degree (complete) atrioventricular block is significantly more severe and requires immediate treatment.  The cause of atrioventricular block in Lyme disease patients is more likely to be Lyme carditis, or inflammation of the heart than the electrolyte disturbances that can occur in patients with lupus suffering from compromised renal (kidney) function. Treatment that works for one condition is, therefore, not always helpful for the other.

lyme disease lupus atrioventricular heart block

Third-degree atrioventricular block (complete heart block) is a rare initial symptom of lupus and Lyme disease

Other Shared Symptoms of Lupus and Lyme Disease

Other symptoms shared by patients with Lupus and Lyme disease include fatigue, fever, rashes, arthritis, and central nervous system complications.  Lupus nephritis and systemic lupus erythematosus (SLE) both result in these symptoms in some patients and may be mistaken for Lyme disease symptoms in a patient already diagnosed with the infection.   Assessing each new symptom on its own merit is important for any patient therefore, and any delays in seeking medical attention may lead to an unnecessary escalation in the severity of their condition. Lyme disease itself may lead to kidney complications that can mirror the symptoms of active lupus nephritis, although Lyme disease kidney failure is usually considered a feature of the disease in dogs rather than humans.

Kidney Dysfunction in Lupus and Lyme Disease


Where lupus is adversely affecting the kidneys, a patient may experience complications with electrolyte regulation and hydration.  Symptoms of lupus may be similar to those of late stage Lyme disease with patients experiencing headaches, dizziness, visual disturbances, and signs of cardiac decompensation or atrioventricular block.   Lupus nephritis is one of the most serious developments in patients with systemic lupus erythematosus and it usually arises within five years of diagnosis.  Renal failure itself rarely occurs without the patient having already met the criteria for SLE however and most patients with lupus are carefully monitored for renal function so as to try to slow down the progression of kidney failure as far as possible.  This treatment may involve the use of aggressive immunosuppressant drugs which would be contraindicated in those with Lyme disease.  This, again, highlights the importance of differentiating Lyme disease, lupus, and other conditions sharing common traits.

Mononeuritis Multiplex

Lupus and Lyme disease may also be part of a group of disorders brought together under the heading of Mononeuritis multiplex.  This is a painful peripheral neuropathy which is asymmetric, asynchronous, and involves both sensory and motor nerve function in at least two distinct nerve areas.  Random nerves can be affected at multiple sites around the body and what starts as an asymmetric condition may progress to become more widespread and symmetric.  Rheumatoid arthritis, Lyme disease, lupus, diabetes, vasculitis, amyloidosis, Sjogren syndrome, AIDS, scleroderma, and a number of other conditions are associated with the complex which is still in its infancy in terms of medical knowledge and understanding.  Although they are distinct medical conditions, Lyme disease and lupus share some common traits and may cause initial confusion if they present atypically in a patient.

References

Arce-Salinas CA, Carmona-Escamilla MA, Rodríguez-García F. Complete atrioventricular block as initial manifestation of systemic lupus erythematosus. Clin Exp Rheumatol. 2009 Mar-Apr;27(2):344-6.