Lyme disease and the orthopaedic implications of lyme arthritis

Abstract

Lyme disease is the most common tick-borne disease in the United States and Europe. Increased awareness of the clinical manifestations of the disease is needed to improve detection and treatment. In the acute and late stages, Lyme disease may be difficult to distinguish from other disease processes. The epidemiology and pathophysiology of Lyme disease are directly related to the Borrelia burgdorferi spirochete and its effects on the integumentary, neurologic, cardiac, and musculoskeletal systems. Lyme arthritis is a common clinical manifestation of Lyme disease and should be considered in the evaluation of patients with monoarticular or pauciarticular joint complaints in a geographic area in which Lyme disease is endemic. Management of Lyme arthritis involves eradication of the spirochete with antibiotics. Generally, the prognosis is excellent. Arthroscopic synovectomy is reserved for refractory cases that do not respond to antibiotics.

Figure 1

Graphic representation of the number of Lyme disease cases reported annually in the United States, from 1992 to 2006. For that period, a total of 248,072 cases were reported in the United States and the District of Columbia. (Reproduced with permission from Bacon RK, Kugeler KJ, Mead PS; Centers for Disease Control and Prevention [CDC]: Surveillance for Lyme disease: United States, 1992–2006. MMWR Surveill Summ 2008;57[10]:1–9.)

Figure 2

Map illustrating the average rate of Lyme disease in the United States per 100,000 population by county of residence from 1992 to 2006. County of residence was available for 98.1% of cases reported in 1992 through 2006. In 2003, Pennsylvania reported 4,722 confirmed cases and 1,008 suspected cases. (Reproduced with permission from Bacon RK, Kugeler KJ, Mead PS; Centers for Disease Control and Prevention [CDC]: Surveillance for Lyme disease: United States, 1992–2006. MMWR Surveill Summ 2008;57[10]:1–9.)

Figure 3

Percentage of symptoms reported by patients with Lyme disease in the United States by month of illness onset from 1992 through 2006. (Reproduced with permission from Bacon RK, Kugeler KJ, Mead PS; Centers for Disease Control and Prevention [CDC]: Surveillance for Lyme disease: United States, 1992–2006. MMWR Surveill Summ 2008;57[10]:1–9.)

Figure 4

Life cycle of the Ixodes tick. Ticks in the nymphal form most commonly transmit Borrelia burgdorferi spirochete to humans in late spring and summer. (Reproduced with permission from Centers for Disease Control Division of Vector-Borne Infectious Diseases: Lyme Disease Transmission. Available at: http://www.cdc.gov/ncidod/dvbid/lyme/ld_transmission.htm. Accessed December 13, 2010.)

Figure 5

Photograph of an erythema migrans rash following a tick bite. (Reproduced with permission from Feder HM Jr: Lyme disease in children. Infect Dis Clin North Am 2008;22[2]:315–326, vii http://www.sciencedirect.com/science/journal/08915520.)

Figure 6

Photograph of a patient with left-sided peripheral facial nerve palsy. She could not wrinkle the left side of her forehead, close her left eye, or lift the left corner of her mouth. (Reproduced with permission from Feder HM Jr: Lyme disease in children. Infect Dis Clin North Am 2008;22[2]:315–326, vii http://www.sciencedirect.com/science/journal/08915520.)

Figure 7

Recommended treatment algorithm for patients with Lyme arthritis. ELISA = enzyme-linked immunosorbent assay, IgG = immunoglobulin G, IV = intravenous, NSAIDs = nonsteroidal anti-inflammatory drugs, PCR = polymerase chain reaction. (Adapted with permission from Steere AC, Angelis SM: Therapy for Lyme arthritis: Strategies for the treatment of antibiotic refractory arthritis. Arthritis Rheum 2006;54[10]:3079–3086.)