Rheumatoid arthritis plays a significant role in the history of Lyme disease as it was a cluster of cases in children of juvenile arthritis that prompted investigation into the condition in Lyme, Connecticut in the 1970s. The paediatric cases were initially diagnosed as being juvenile idiopathic arthritis, or rheumatoid arthritis, before re-assessment following similar symptoms in soldiers at a nearby military base. The term Lyme arthritis was then coined to describe the symptoms resulting from infection with Borrelia burgdorferi. This infection prompts the body to produce elevated levels of pro-inflammatory cytokines, or immune system cells, and genetic factors such as human leukocyte antigen (HLA)-DR4 and HLA-DR2.
The production of such factors appears to be more problematic in patients with particular genetic profiles, namely those with HLA haplotype DR4 or DR2. Such patients, when they also produce antibodies to OspA and OspB (the outer surface proteins expressed by Borrelia burgdorferi) in their joint fluid, appear to be more susceptible to long-term Lyme disease arthritis symptoms. The hypothesis is that an autoimmune reaction occurs which can lead to chronic inflammation, and arthritis pain, even after Lyme disease is successfully treated and eradicated.
Diagnosing Lyme Disease Accurately
Differentiating Lyme disease, Rheumatoid arthritis, ankylosing spondylitis, and other conditions such as gout, or lupus can be difficult for a physician. Obtaining a detailed medical history is important as the patient may have experienced Bell’s palsy, peripheral neuropathy, cognitive defects (such as memory or concentration problems), an unexplained rash, or heart palpitations which may lead a physician to suspect Lyme disease rather than simple wear and tear on the joints and osteoarthritis. Lupus and Lyme disease can share similar symptoms involving cardiac abnormalities, cognitive problems, joint pain, and fatigue, as can Rheumatoid arthritis, chronic fatigue syndrome, and fibromyalgia.
Co-infections of Lyme Disease
Serological tests may uncover co-infections such as Babesiosis, ehrlichiosis (human granulocytic anaplasmosis), or Rocky Mountain spotted fever which could also create inflammation and exacerbate any joint pain. Care should be taken with blood tests carried out fairly promptly after a tick bite however, as the false-negative rate for ELISA in early disease is thought to be around 30%, with antibodies only really reaching detectable levels at six to eight weeks post-infection. Rheumatoid arthritis itself can compromise the test results, as can lupus, through their impact on inflammation in the body and self-reactive antibody production.
Treating Lyme Disease and Rheumatoid Arthritis
Most cases of Lyme arthritis will respond to oral antibiotic treatment, but cases that are misdiagnosed as Rheumatoid arthritis leading to a patient being prescribed oral steroids or intra-articular steroid injections may become more difficult to treat. Steroid medications should be avoided in cases of Lyme arthritis as their modulation of the immune system may lead to a persistent bacterial infection.
Oral antibiotic treatment for Lyme arthritis will usually involve 30 days of ceftriaxone or doxycycline, followed by a second course of antibiotics along with hydroxychloroquine should the first dose not be successful and persistent synovitis occur. Patients may have synovial fluid extracted to test for the presence of Borrelia burgdorferi (using PCR testing), and antibodies to the spirochaetes. The joint lesions resulting from Lyme disease and rheumatoid arthritis are usually very similar and patients may require such tests to differentiate the two.
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