Arthritis Self-Management

Lyme Disease

by Robert S. Dinsmoor

An inflammatory infection, transmitted by blacklegged ticks (also known as deer ticks), that can cause acute or recurring arthritis-like symptoms. Lyme disease was first encountered in the early 1970’s, when an unusual number of cases of juvenile arthritis were discovered in Lyme, Connecticut, and nearby towns. Researchers soon found that all of the affected children lived and played near wooded areas inhabited by ticks. Eventually, they discovered that the outbreak was caused by bites from tiny deer ticks carrying the bacterium Borrelia burgdorferi.

The first symptom of Lyme disease usually is a red rash called erythema migrans, which starts as a small red spot at the site of the tick bite. Over the ensuing days or weeks, the spot enlarges to form a circular or oval-shaped rash. Often the rash takes on a hallmark “bull’s eye” pattern — a red ring with a red pinpoint in the center. As the infection spreads, rashes may appear elsewhere on the body, often accompanied by intermittent fever, headaches, and fatigue.

If not treated with antibiotics, roughly half the people infected develop recurring episodes of painful or swollen joints. These flare-ups may last anywhere from a few days to a few months and can shift from one joint to another. A small percentage of untreated individuals eventually develop chronic arthritis.

Lyme disease may also affect the nervous system, causing meningitis (stiff neck and headache), Bell palsy (temporary paralysis of the facial muscles), and numbness, pain, or weakness of the limbs. A very small percentage of people may develop heart problems, such as an irregular heartbeat.

Diagnosing Lyme disease can be difficult, because its symptoms mimic those of other diseases, and often people don’t remember being bitten by a tick. Doctors may use a medical history and physical examination to guide their diagnosis. The diagnosis is usually confirmed using blood tests that detect the presence of antibodies to B. burgdorferi.

Lyme disease can be treated very successfully using antibiotics, and the sooner they are given, the more effective they are. Oral antibiotics such as doxycycline, cefuroxime axetil, or amoxicillin can be prescribed early in the course of the infection to help heal the rash and prevent joint and nerve complications. People who go on to develop these complications may need to be treated with intravenous antibiotics.

Even though most cases of Lyme disease can be treated successfully, prevention is still the best medicine. One of the best preventive measures is to avoid exposure to deer ticks, which thrive in heavily wooded areas and nearby grasslands, especially in the summer. Walk in the center of trails to avoid contact with ticks in surrounding grass and brush. Wear long pants, long-sleeved shirts, and footwear that doesn’t leave any part of the foot exposed. Wear light-colored clothing to make ticks easier to spot, and spray clothing and skin with insect repellent containing DEET. When coming in from the outdoors, check your body, especially hairy areas, for ticks, and wash all clothing. Examine your pets for ticks before you let them in the house, as ticks can fall off the pet and attach themselves to people.

If you do find a tick that has latched onto your skin, forget the old wives’ tale about burning it off. Instead, pull it out gently with tweezers, trying not to squeeze the tick’s body, and apply an antiseptic to the site. Fortunately, according to the National Institutes of Health, a tick must stay attached for at least 48 hours to be able to transmit the bacteria, so removing ticks promptly can almost always prevent infection.

Last Reviewed on July 21, 2010

Robert S. Dinsmoor is a medical writer and editor based in Massachusetts. 

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