According to a new study carried out in Halifax, NS, Canada, there has been a spike in the number of people seeking treatment for arthritis that is later discovered to be due to infection with Borrelia burgdorferi, the Lyme disease bacteria.
Huge Jump in Lyme Disease Cases in Children
The study, presented at the American College of Rheumatology conference in Florida in early April detailed 17 counts of arthritis in children, many of which were documented in Lunenberg County since 2012. In most cases the children were unaware that they had Lyme disease and were referred to rheumatologists to uncover the cause of their painful, swollen joints. After being diagnosed with Lyme arthritis, some of the kids were then also found to have neurological issues related to the infection.
Symptoms of Lyme in North America
Arthritis is a common symptom of Lyme disease in North America but is less common in European cases of the disease. Instead, neurological manifestations are thought more likely with infection by the strains of the Borrelia bacteria found in Europe. Conversely, neurological symptoms are thought less likely in US and Canadian Lyme disease cases as it is almost always Borrelia burgdorferi sensu stricto that causes infection, not B. afzelii or B. garinii, unless patients have recently travelled outside the country.
As we’ve noted many times before on LymeDiseaseGuide.org, symptoms of the infection can arise weeks, months, or even years after a tick bite, assuming that the infection was not diagnosed and successfully treated. Where treatment has successfully eradicated the bacteria any recurrent symptoms are more likely to be caused by a repeat infection than residual issues related to an earlier infection.
In these latest cases, the majority of the children were unaware that they had been bitten by a tick, with their joint pain constituting the first symptom of Lyme observed. This is not a case of Lyme-Panic as many of the families involved were, apparently, surprised that the children had the infectious disease.
Five-Fold Increase in Lyme
However, one public health office in southern Ontario reports a five-fold increase in cases of Lyme disease in the past year, with arthritis a key symptom for many. Endemic areas are now listed in New Brunswick, Nova Scotia, Quebec, Ontario, Manitoba and B.C., and cases have risen from 128 in 2009 to 315 in 2012, according to the Public Health Agency of Canada.
Problems Diagnosing Lyme Disease
Many people still consider Lyme disease to be absent from Canada, meaning that patients and doctors don’t necessarily tie together symptoms of the infection which can range from joint pain to abnormal heart function, neurological symptoms, fatigue, and the Lyme disease bull’s-eye rash. As arthritis is unusual in children this presents a specific symptom which parents can take to their physician for investigation. Children suffering with difficulties concentrating or who are suffering from low energy or visual disturbances may not be able to sufficiently articulate those symptoms to then receive medical attention.
Fortunately, once Lyme disease is diagnosed, the majority of cases are easily treated with antibiotics, sometimes intravenously. The US Centers for Disease Control suggests a two week treatment with an antibiotic like doxycycline, or a longer course if this fails to successfully eliminate infection. In these latest cases 50% of the children were successfully treated with one course of intravenous antibiotics, with the rest requiring two to three courses.
After five months, however, two patients continued to experience disability due to ongoing arthritis symptoms, which may suggest either a secondary cause of the joint pain or more significant initial tissue damage as Lyme disease went unrecognised and untreated for many months. Most doctors are very clear, however, that this does not mean that these children have chronic Lyme disease and nor do they need ongoing antibiotic treatment (which can have severe side effects).
Pediatric Arthritis Sentinel for Lyme Disease
The latest study, co-authored by Dr. Elizabeth Stringer, a rheumatologist at Halifax’s IWK Health Centre, details a similar spike in cases as that which originally led to the discovery and naming of Lyme disease in the mid-1970s. The disease is named after Old Lyme, a town in Connecticut, where a sudden surge in cases in juvenile arthritis prompted experts, including Allen Steere, to investigate. When it turned out that navy personnel at a nearby base were also seeing symptoms of arthritis the focus switched from juvenile arthritis to a more ubiquitous cause, namely infection with Borrelia burgdorferi.
Pediatric arthritis has become something of a sentinel for Lyme disease as joint pain in a number of children in a specific area may very well demonstrate the presence of ticks in the area who are carrying Lyme disease bacteria. Increased cases of dogs and horses with Lyme disease may also offer an early warning sign of the presence of ticks infected with Lyme disease, especially as animals are more likely to come into contact with ticks in long grasses, as might children playing outdoors.