Does Lyme disease cause migratory arthritis, moving swelling to different joints?

Migratory Arthritis in Lyme Disease

Yes, Lyme disease can cause migratory arthritis with swelling that moves between different joints. This is a characteristic feature of untreated Lyme disease, particularly in its later stages 1.

Patterns of Joint Involvement in Lyme Disease

Lyme arthritis typically progresses through several phases:

Early Disease

• Initially, patients may experience migratory musculoskeletal pain in joints, bursae, tendons, muscle, or bone
• These pains often last only hours or days in a given location before moving elsewhere 2
• This occurs during the early disseminated phase, typically weeks to months after the initial tick bite

Later Disease

• Untreated patients often develop intermittent attacks of oligoarticular arthritis
• About 60% of untreated patients develop brief attacks of arthritis primarily in large joints 3
• The knee is most commonly affected, but other large joints can be involved 1, 4
• Episodes of arthritis often become longer during the second or third years of illness 3
• In approximately 10% of patients, chronic arthritis develops 3

Clinical Characteristics of Lyme Arthritis

• Migratory pattern: Joint symptoms can move from one joint to another over time 2
• Intermittent nature: Episodes of joint swelling may spontaneously resolve after weeks to months, only to recur in the same or different joints 1
• Disproportionate swelling: Large knee effusions that are out of proportion to the pain are typical 1
• Predilection for large joints: Weight-bearing joints, especially the knee, are most commonly affected 1, 4
• Foot and ankle involvement: Less commonly, the small joints of the foot can be affected 5

Diagnostic Considerations

Confirmation of Lyme arthritis requires:

• Appropriate clinical picture (joint swelling, especially of large joints)
• Exposure in an endemic area
• Positive serologic testing (two-tier testing with ELISA and IgG immunoblot) 2
• In seropositive patients, PCR testing of synovial fluid can add diagnostic certainty 1

Important Caveats

• Persistent joint swelling: In approximately 10% of patients with Lyme arthritis, joint swelling (usually of a single joint) will persist after recommended antimicrobial treatment courses 1
• Not always migratory: Persistent swelling of the same joint for 12 months would be an unusual presenting manifestation of Lyme arthritis 1
• Differential diagnosis: In adults, Lyme arthritis most resembles Reiter's syndrome or reactive arthritis; in children, it is similar to pauciarticular juvenile rheumatoid arthritis 3
• Post-treatment symptoms: Some patients develop fibromyalgia-like symptoms after Lyme disease treatment, with diffuse joint and muscle pain that does not respond to antibiotics 2

Treatment Implications

• Early recognition and treatment of Lyme disease can prevent the development of arthritis
• Lyme arthritis can usually be treated successfully with 1-month courses of oral doxycycline or amoxicillin, or with 2-4 week courses of intravenous ceftriaxone 2
• Patients with certain genetic markers (particularly HLA-DR4 or HLA-DR2) may be more susceptible to developing chronic arthritis despite antibiotic treatment 3

Understanding the migratory nature of joint involvement in Lyme disease is important for proper diagnosis and timely treatment to prevent long-term complications.