Lyme Disease, Lupus, and Diagnosis

by lmatthews on May 3, 2012

lupus rash common sites

Lupus and Lyme disease rashes are usually distinct

Lyme disease is frequently misdiagnosed as Lupus, and in some cases Lupus may be misdiagnosed as Lyme disease. The consequences of such misdiagnoses can be devastating as patients may suffer lengthy delays in obtaining adequate treatment for their condition and permanent damage or degeneration can occur. A quick look at the similarities between Lupus and Lyme disease makes it easy enough to see how the mistake can occur and physicians working in areas where Lyme disease is endemic, particularly where it has recently spread or been newly identified, may wish to familiarize themselves with the disease overlap.

Lyme Disease and Lupus Symptoms

Lupus is an autoimmune disease that can attack the joints, heart, kidneys, and other organs and bodily systems. The symptoms of Lupus may include joint pain, muscle pain, back ache, a butterfly rash across the bridge of the nose and cheeks, abnormal heart rhythm and pulse, depression, and problems with concentration or other cognitive issues. Those who have experienced Lyme disease are likely familiar with a number of these symptoms with Lyme arthritis, Lyme carditis, and neuroborreliosis sometimes mistaken for autoimmune problems, degenerative joint conditions such as osteoarthritis, or even depression or anxiety disorders affecting mood and cognition. Where a whole host of symptoms arise it may be that both Lupus and Lyme disease are present, or that one is being accentuated by the other. Treating Lupus and ignoring the possibility of infection with Borrelia will make it harder to manage symptoms and can also mean that symptoms linger for far longer than they would if treated appropriately. Conversely, treating Lyme disease alone may ignore the progressive nature of Lupus and could also act to stimulate the immune system (depending on the patients’ treatment) which would then cause further issues if the autoimmune disorder is indeed present.

Diagnosing Lyme Disease and Lupus

A physical examination which reveals the presence of a Lyme disease rash makes the diagnosis of Lyme disease much simpler but physicians should not then discount the possibility that other symptoms are solely due to the infection as the patient could be suffering Lupus and Lyme simultaneously. Similarly, the detection of a butterfly rash associated with Lupus should not necessarily rule out an infection with Borrelia. A major problem arises for patients with suspected Lupus or Lyme disease when a blood test called ANA is used to diagnose Lupus. An elevated level of anti-nuclear antibodies in a patient often prompts a diagnosis with Lupus but ANA can also be raised in patients with Lyme disease.

Lupus Arthritis and Lyme Disease

Lupus arthritis commonly affects a number of joints including the smaller joints of the hands, wrists, ankles, and toes, as well as larger joints such as the knees. Lyme disease tends to show itself in a single large joint such as the knee, and rarely in more than one or two joints. Lyme arthritis is also cyclic so symptoms may be acute and severe and then disappear for weeks or months at a time; unfortunately, Lupus arthritis is also cyclic making diagnosis difficult. The joints are painful and swollen in both Lupus and Lyme disease but the joint problems are rarely progressive in either condition, unlike in osteoarthritis or rheumatoid arthritis. Arthritis and muscle pain are much more common in Lupus than in Lyme disease however, with 90% of Lupus patients experiencing joint and/or muscle pain at some point in their illness and 10-20% of Lyme disease patients suffering similar symptoms.

Lupus and Chronic Lyme Disease

Fever is a symptom of both Lupus and early-stage Lyme disease but it is rarely connected to chronic Lyme disease. Where feverish symptoms arise in Lupus this usually accompanies a flare-up of the disease. Fatigue is also a feature of Lupus and Lyme disease, particularly in the early stages or where chronic Lyme disease remains untreated. The fatigue associated with Lupus is usually relentless and profound whereas it may be intermittent in cases of chronic Lyme disease or short-lasting in early stages of the infection. It is also worth noting that fatigue may arise in association with the difficulty of getting an accurate diagnosis and explanation of other symptoms, as can anxiety, depression, insomnia, and other stress-related symptoms that may be included in a diagnosis itself; obtaining an accurate timeline of symptom development can be particularly helpful in assessing the nature of the illness(es).

lupus and lyme disease symptoms

The symptoms of Lupus overlap with symptoms of Lyme disease.


Lyme Disease Headaches and Lupus

Headaches are a Lyme disease symptom, a symptoms of Lupus, and a symptom of stress, making it difficult to determine the exact cause of the condition. Persistent headaches may occur in cases of untreated, or unresolved Lyme disease infection and may be associated with inflammation, central nervous system infection, muscle or joint pain, or other effect of infection. In cases of Lupus, headaches are associated with changes in the blood vessels in the head and may be controlled with medications targeted at these changes rather than through analgesics alone.

Lyme Carditis and Lupus

Patients with Lyme disease may experience abnormal cardiovascular function as the infection can spread to the heart and cause palpitations, atrioventricular block, and dizziness, fainting spells, or alterations in blood pressure control. Atrioventricular block may also occur in rheumatic fever and in cases of Lupus, particularly in neonatal lupus erythematosus. This change in heart rhythm can be shortlived and resolved easily with time or as treatment takes effect. However, treating an AV block resulting from a Lyme disease infection with a pacemaker or immunosuppressants following misdiagnosis with Lupus can make the difference between a prompt recovery and a lengthy battle with heart palpitations, and even permanent cardiac issues or heart failure. Successful treatment of Lyme carditis with antibiotics usually means that no permanent heart problems occur and no pacemaker is required, highlighting the importance of accurate diagnosis when considering Lyme disease and Lupus. Atrioventricular block is rarely the first symptom of Lupus that brings a patient to seek medical attention although rare cases do exist where acute atrioventricular block has been quickly followed by serositis, kidney problems, and joint issues requiring immediate treatment. AV block in Lyme disease may not even be observed until a standard electrocardiogram is run during diagnosis, and first-degree AV blocks may not need specific treatment unlike complete (third-degree) atrioventricular blocks that can arise in cases of Lupus. Treatment for Lyme carditis is unlikely to help in cases of AV block from Lupus as the former is normally due to inflammation and the latter due to abnormalities in electrolytes following kidney issues.

The degree of overlap between Lupus and Lyme disease is clear and it is easy to see why physicians unfamiliar with Lyme disease infection could attribute symptoms to the more commonly diagnosed autoimmune disease. As Lyme disease awareness increases it may be that many more patients are diagnosed faster and treated earlier and more effectively to prevent permanent tissue damage and the stress of a lengthy diagnosis ordeal. It is also possible that a patient already diagnosed with Lupus also becomes infected with Lyme disease and so they, and their physician, should be wary of collecting any new symptoms under the single disease. With symptoms of arthritis, heart problems, mental health, headaches, and even kidney disease healthcare professiionals need to be alert to the possibility of misdiagnosis of Lupus and Lyme disease.

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