Musculoskeletal manifestations of Lyme disease
- Robert T Schoen, MD
Robert T Schoen, MD
- Clinical Professor of Medicine
- Yale University School of Medicine
Lyme disease was first recognized in the United States in the 1970s, presenting as oligoarthritis during an outbreak in children in Lyme, Connecticut . Lyme disease is now the most common vector-borne illness in North America and Europe. Arthritis is the most common manifestation of late Lyme disease . Because antibiotic treatment of early infection is usually curative, arthritic complications have become less common .
The clinical features, diagnosis, and therapy of the musculoskeletal manifestations of Lyme disease will be reviewed here. General issues related to the clinical manifestations, diagnosis, and treatment of Lyme disease are discussed separately. (See "Clinical manifestations of Lyme disease in adults" and "Lyme disease: Clinical manifestations in children" and "Diagnosis of Lyme disease" and "Treatment of Lyme disease".)
The clinical manifestations of Lyme disease can generally be divided into three phases: early localized, early disseminated, and late disease (table 1). However, the clinical features of each stage can overlap and some patients present in a later stage of Lyme disease without a history of prior signs or symptoms suggestive of earlier disease . (See "Clinical manifestations of Lyme disease in adults", section on 'Clinical stages'.)
Lyme arthritis is a late finding of Lyme disease, whereas migratory or transient arthralgias can occur during the early localized or early disseminated stages, as discussed below. (See 'Clinical features' below.)
Early Lyme disease occurs primarily during the late spring and early summer when nymphal Ixodes ticks are active (figure 1 and figure 2). In contrast, Lyme arthritis may begin in any season, weeks to months after initial infection. Affected individuals are typically active outdoors in locations endemic for Lyme disease (figure 3). (See "Epidemiology of Lyme disease".)
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- CLINICAL STAGES
- CLINICAL FEATURES
- Antecedent erythema migrans
- Lyme arthritis
- DIFFERENTIAL DIAGNOSIS
- LABORATORY TESTING
- Culture and PCR
- MANAGEMENT OF LYME ARTHRITIS
- Clinical trials of antibiotics
- Antibiotic regimens
- - Without neurologic involvement
- - With neurologic involvement
- Adjunctive therapies
- - Antibiotic-refractory Lyme arthritis
- Activity restrictions
- POST-LYME DISEASE SYNDROME (CHRONIC LYME DISEASE) AND FIBROMYALGIA
- Distinction from fibromyalgia
- Post-Lyme disease syndrome
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS