Lyme

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Lyme Arthritis
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Lyme disease is a tick-transmitted inflammatory disorder
characterized by an early focal skin lesion, and subsequently a growing
red area on the skin (erythema chronicum migrans or ECM). The disorder
may be followed weeks later by neurological, heart or joint
abnormalities.


Symptomatology
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The first symptom of Lyme disease is a skin lesion. Known as
erythema chronicum migrans, or ECM, this usually begins as a red
discoloration (macule) or as an elevated round spot (papule). The skin
lesion usually appears on an extremity or on the trunk, especially the
thigh, buttock or the under arm. This spot expands, often with central
clearing, to a diameter as large as 50 cm (c. 12 in.). Approximately
25% of patients with Lyme disease report having been bitten at that
site by a tiny tick 3 to 32 days before onset of ECM. The lesion may be
warm to touch. Soon after onset nearly half the patients develop
multiple smaller lesions without hardened centers. ECM generally lasts
for a few weeks. Other types of lesions may subsequently appear during
resolution. Former skin lesions may reappear faintly, sometimes before
recurrent attacks of arthritis. Lesions of the mucous membranes do not
occur in Lyme disease.

The most common symptoms accompanying ECM, or preceding it by a
few days, may include malaise, fatigue, chills, fever, headache and
stiff neck. Less commonly, backache, muscle aches (myalgias), nausea,
vomiting, sore throat, swollen lymph glands, and an enlarged spleen may
also be present.

Most symptoms are characteristically intermittent and changing,
but malaise and fatigue may linger for weeks.

Arthritis is present in about half of the patients with ECM,
occurring within weeks to months following onset and lasting as long as
2 years. Early in the illness, migratory inflammation of many joints
(polyarthritis) without joint swelli...