Lyme Disease Overview (with focus on joints)

Different joint manifestations occur during different stages (some overlap):
  • Early Localized:  generalized arthralgias
  • Early Disseminated:  migratory arthralgias
  • Late:  mono- / oligo-arthritis

See posting Polyarthralgias.

STAGES OF LYME DISEASE — from time of tick exposure

Early Localized (1-4 wks)
  • Erythema Migrans (EM) lesion(s)  [see pix below]
  • Generalized arthralgias, myalgias, fatigue, malaise, “viral syndrome”
  • Serology Negative
Early Disseminated Disease (few wks to few months)
  • Migratory Arthralgias [order serology if any of following Sx]
  • Multiple EM lesions *
  • Meningeal Sx *
  • Cranial Nerve Palsies (esp. facial nerve) *
  • Radiculopathy / Peripheral neuropathy *
  • Cerebellar Ataxia *
  • Carditis (A-V Block, often asymptomatic) *
  • Serology:  IgM Positive, maybe IgG
Late (months to years)
  • Joint:  Mono- / Oligo-arthritis of  large joints (esp. knee)
  • Neuro:  Mild cognitive deficits; radicular pain; neuropathy
    In Europe:  Maybe true ecephalitis; cranial nerve deficits; spastic paraparesis
  • Serology:  IgG Positive


Vast Majority of cases: VA (northern tip), MD, DL, NJ, PA, NY (eastern), New England, Wisc, Minn.
  • Forested areas
  • Also suburbs of Boston, NYC, Phila
Tick Season:  June – August
  • Most pts don’t notice tiny nymph ticks
DIAGNOSIS  —  Antibodies to Borrelia burgdorferi (ELISA / IFA; Western Blot)
  • MUST have typical symptoms / findings
  • Serology is supportive
Early Localized  —  EM lesion(s)
  • Serology negative
Early Disseminated  —  Symptoms PLUS Serology
  • If negative = No Lyme Disease
  • If positive: confirm with Western Blot IgM and IgG
Late  —  Symptoms PLUS Serology
  • If negative = No Lyme Disease
  • If positive: confirm with Western Blot IgG
Note  —  Many residents of endemic areas are seropositive from prior asymptomatic infection
  • Serology only useful for specific clinical symptoms
  • EM lesions (rash is diagnostic: just Tx)
  • Arthralgias / myalgias without other symptoms of Early Disseminated Disease
  • Screen asymptomatic people

Erythema Migrans (EM)  (Multiple Lesions in ~20% of Pts)

Note characteristic central clearing may evolve slowly; lesion may be simply all red on initial presentation.



Multiple EM Lesions