What Is Lyme Arthritis?

Lyme arthritis is a chronic condition that occurs when the bacteria that cause Lyme disease make its way into joint tissues and cause inflammation. If the infection is not treated, permanent damage to the joints can occur. Lyme arthritis is common, affecting 25% of all Lyme disease cases.

Arthritis is terribly painful


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Symptoms

Lyme arthritis is considered one of the most common chronic conditions associated with Lyme disease. The most notable symptoms in those with chronic Lyme arthritis include swelling and pain in one or a few joints. The body parts that are most often affected by Lyme arthritis include:

  • Knees
  • Shoulders
  • Ankles
  • Elbows
  • Jaw
  • Wrists
  • Hips

Unlike other types of arthritis, Lyme arthritis is likely to be asymmetrical. This means it does not affect both sides of the body the same way. It causes pain and swelling only in select joints. In typical cases of other types of arthritis, joints on both sides of the body will be affected.

The pain and swelling associated with Lyme arthritis tend to come and go, and the joints often swell up significantly. Since Lyme arthritis mimics other types of arthritis such as rheumatoid arthritis, it can be difficult to diagnose if a Lyme disease infection is not suspected.

The quicker you receive treatment for Lyme disease, the better. If you suspect you may be developing Lyme disease-induced arthritis, contact your doctor right away to discuss testing and treatment options.

Causes

Lyme arthritis occurs when Lyme disease bacteria enter joint tissues and cause inflammation. The only way to contract Lyme disease is via a bite from an infected tick. The bacterium responsible for the infection is commonly Borrelia burgdorferii. However, rare instances of the infection have been caused by Borrelia mayonii.

In the United States, Lyme disease is the most common vector-borne illness and is typically found in black-legged ticks.

The Borrelia bacterium is a type of spirochete that invades all areas of the body once it enters the bloodstream. Chronic infections with the Lyme disease-causing bacteria can sometimes occur following treatment because of the bacteria's ability to hide among vulnerable tissues within the body. They do so by attaching themselves to cells that line the blood vessels while traveling throughout the body using a special surface protein. Typical symptoms of Lyme disease occur hours to weeks following the infection, with Lyme arthritis typically presenting itself any time within the first four weeks and up to years following the initial infection.

Since the Borrelia bacteria invade the sensitive tissues that line the joints, they can cause damage to the cartilage, resulting in Lyme arthritis. Roughly 60% of those with untreated Lyme disease will develop Lyme arthritis. For most, Lyme arthritis is highly treatable with antibiotics within 30 days. However, in some cases, the bacteria may continue to damage the tissues even after Lyme disease is treated.

Bacterial Structure

The unique peptidoglycan structure of the Borrelia bacteria is the cause behind a chronic case of untreatable Lyme arthritis. A peptidoglycan cell wall matrix is made up of proteins and sugars that are designed to keep the cells intact. Where most of these types of bacteria reuse their peptidoglycans, Borrelia bacteria do not. They shed them as they replicate, leaving peptidoglycans throughout the body. This then leads to an inflammatory response initiated by the immune system to get rid of the peptidoglycans, but this process also produces inflammation around the joints, which worsens the symptoms of Lyme arthritis.

Diagnosis

Diagnosis of Lyme arthritis can be difficult if no tick bite is suspected because it can mimic other types of arthritic conditions. The first step toward diagnosing the disease is therefore identifying a Lyme disease infection through a physical examination to determine if a tick bite is present. Tick bites will appear as a bulls-eye type rash at the site of the bite, so they are typically easy to see if the examination occurs early in the infection cycle. There are other types of tests that doctors can perform to determine if the Borrelia bacteria are causing arthritic symptoms.

Serologic Testing

There are two different serology tests that are generally performed in the case of suspected Lyme arthritis. The first is an enzyme-linked immunosorbent assay, otherwise known as an ELISA test. A sample of blood will be taken to determine the presence of antibodies. Once a positive result is returned from the ELISA test, a Western Blog (WB) will be conducted to confirm the positive diagnosis.

Polymerase Chain Reaction (PRC)

The PCR testing method is done using synovial fluid to help determine the presence of the bacteria prior to treatment. Once treatment with antibiotics starts, a PCR test will not be as effective. The PCR test is only used as further diagnostic support following a positive serology result for Lyme disease.

Joint Aspiration

To help rule out other types of arthritic conditions, joint aspiration may be conducted. This test is done using samples of synovial fluid. Synovial fluid is found within the joints and can help to determine whether other forms of arthritis are causing the joint pain and damage.

Imaging and Other Tests

In Lyme arthritis, the joints and tissues surrounding the joints can become inflamed, swollen, and damaged. Certain imaging tests such as MRI or ultrasound can help your doctor visualize the damage in the joints as well as any other abnormalities that may be occurring. Imaging scans are generally used to assess the extent of the damage following a positive result of Lyme disease.

Treatment

Lyme arthritis is usually treated with a four-week course of oral antibiotics. Those with persistent joint inflammation and pain after the first course of antibiotics may require a second course of antibiotics. Treatment with lyme arthritis may happen at the same time as lyme disease treatment.

The antibiotics typically used include:

  • Doxycycline
  • Amoxicillin
  • Cefuroxime

These antibiotics were shown to be effective at resolving Lyme arthritis. The two used most commonly to treat Lyme arthritis are doxycycline and amoxicillin. In some people with persistent Lyme arthritis, intravenous antibiotic therapy using ceftriaxone may be administered.

For the 10% of people who don’t respond to antibiotic treatment at all, other forms of treatment may be needed to help curb the inflammation caused by the immune response. It was found that certain immune-dampening medications such as methotrexate and TNF (tumor necrosis factor) inhibitors could help those with persistent and untreatable Lyme arthritis.

Prognosis

In the majority of Lyme arthritis cases, the first 30-day round of antibiotics or the following four-week IV treatment leads to a complete resolution of symptoms. In a number of cases where treatment is postponed for too long, permanent damage of the joints and tissues can occur, and managing and coping with the symptoms is the only way to deal with the pain and inflammation caused by the damage. As many as 300,000 people will become infected with Lyme disease each year, with about 25% of those cases developing Lyme arthritis.

Since treatment for the disease is fairly simple, the majority of people suffering from the symptoms associated with Lyme arthritis see a complete resolution of their symptoms following antibiotics.  

Coping

To manage the symptoms associated with joint swelling and inflammation caused by Lyme arthritis, you can take nonsteroidal anti-inflammatory drugs or other over-the-counter medications to help relieve the pain caused by the damaging of tissues. These particular pain relievers can help reduce the inflammation. Since the condition can be treated fairly quickly and efficiently, it’s also important to follow through with a treatment plan. Many people with Lyme arthritis who participate in antibiotic treatment find complete relief from their symptoms.

If the joint pain becomes unbearable, it is suggested that you walk with assistance if possible and avoid overuse of the joints that may lead to worsened damage and further inflammation.

Once you have undergone treatment, it’s vital to monitor any other symptoms that you may be experiencing to rule out a persistent case of Lyme arthritis that may return to cause joint pain and swelling all over again. If symptoms do persist, contact your doctor right away for further treatment options.

Prevention

Preventing a tick bite is the most effective way to prevent lyme arthritis. Blacklegged ticks live in moist and humid environments, particularly in and near wooded or grassy areas. When walking in these areas, walk in the center of trails and avoid walking through tall bushes or other plants.

To avoid transmission of the Borrelia bacteria that cause Lyme disease, when out in wooded areas, use insect repellents like bug sprays with DEET or oils of lemon eucalyptus and wear loose-fitted clothing that covers all areas of the body where a tick may be able to latch on to. The Environmental Protection Agency has an online tool to help you find an insect repellent that works best for you and your family.

A Word from Verywell

Dealing with Lyme arthritis can be difficult, especially if you don’t know you have Lyme disease in the first place. Treatment for Lyme arthritis is generally effective, and early recognition and interventions lead to a full recovery in the majority of cases. If you recently spent some time outdoors and experience joint pain and swelling afterwards, see a doctor immediately to evaluate for Lyme disease and Lyme arthritis.

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