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Lyme Arthritis

Lyme disease is the most common vector-borne disease in the United States. It is caused by the spirochetal bacterium Borrelia burgdorferi, and it is transmitted to humans by the “bites” of certain kinds of ticks. Lyme disease cannot be transmitted from an infected person to another person. The infection can involve multiple organ systems and has myriad manifestations, but is rarely, if ever, fatal.

Musculoskeletal manifestations of Lyme disease are very common. During early infection, migratory joint pains and pain in bursae, tendon, muscle, or bone occur in the majority of patients. Weeks to months later, frank arthritis, most commonly involving large joints (most commonly knees, but also shoulders, ankles, elbows, and other sites), may develop. Lyme arthritis is one manifestation of persistent or late Lyme disease. In the United States, approximately 60% of untreated patients will develop intermittent episodes of joint pain and swelling, months to years after the infecting tick bite. The most common presentation is a single involved knee, but both large and small joints may be affected, and usually only one or two joints at a time. Over time, the frequency and severity of attacks can decline. Approximately 10% of untreated patients may develop chronic arthritis, defined as one year or more of continuous joint inflammation.