Increasingly common cause of arthritis, first described in 1977 – especially on East Coast of USA, but it is spreading to other regions, where it is the most common vector borne disease in the USA but occurs world wide. Multisystem infectious disease caused by infection by spirochaete (Borrelia burgdorferi) usually spread by the Ixodes dammini, pacificus or scapularis tick, often associated with deer. Peak incidence is early summer. Mean age of onset = 11 years. M=F.
After local bite infection (lasts 3-32 days) spread to develop skin rash (erythema migrans) then spirochaete spreads systemically (early disseminated stage) fever, headaches and neck stiffness and other systemic manifestations (meningitis, cardiac involvement, arthritis) – can last for up to 9 months followed by late persistent stage with long term cardiovascular, neurologic and rheumatological complications.
Diagnosis is based on clinical findings, exposure to tick and positive antibody to the Borrelia organism and/or a positive Western blot analysis.
Course is one of exacerbations and remissions.
Early musculoskeletal features – migratory pain in joints, tendons, bursitis, bone – usually asymmetric and involves only a few joints – usually knees.
Later prolonged arthritic attacks, peripheral enthesopathy, periostitis
10% have pain in hands or feet – maybe plantar fasciitis or a tendonitis.
Antibiotics (doxycycline, amoxicillin and ceftin) in early disease prevents later complications. Chronic arthritis may take up to 3 months to respond to antibiotics.
Later stages – IV antibiotics
Avoidance of tick infested areas; personal protective measures (eg repellents, clothing); vaccination (LYMErix™); removal of ticks attached to clothes; public health measures to reduce the tick population.