Lyme Arthritis: A Primer for Primary Care

Abstract

Lyme disease is caused by a bacteria belonging to the Borreliaceae family. Wooded forests and terrains are affected, including those in the Northeastern United States. Teenage ticks are most commonly discovered on humans as those ticks need to satisfy their nutritional requirements for growth. They bite warm, moist areas of the body and take 24 to 48 hours to transmit the Borrelia Burgdorferi infection. Lyme disease manifests as a multisystem disorder in humans, and is known for its dermatological, neurological and rheumatological findings. For the primary care provider, Lyme disease should be on the differential in multisystem diseases. Our case is a 63 year old gentleman who presented with unilateral knee pain for the last 3 months. He initially visited the outpatient orthopedic outpatient office for this arthritic pain. Before moving forward with knee replacement he was eventually tested for Lyme Serology IgG and IgM tests. His positive results warranted Lyme Western Blot testing which confirmed the suspicion of lyme arthritis secondary to Borrelia Burgdorferi. He was treated with a 14 day course of doxycycline, which resulted in significant improvement of knee pain and return to baseline functionality without surgical intervention. The purpose of this report is to stress the importance of beginning doxycycline as soon as possible to avoid progression into other organ systems such as worsening rheumatologic arthritis, central nervous system neuropathies, peripheral nervous system palsies, or cardiac atrioventricular blocks. The optimal treatment is obtained with thorough history taking and physical examination.