Because its symptoms mimic those of so many other diseases – both tick-borne and otherwise – Lyme disease is often misdiagnosed. One of the most common Lyme disease misdiagnoses is Rheumatoid Arthritis (RA), a chronic condition with less clear causes than Lyme disease.
Though there are many fundamental differences between these two conditions, it’s true that arthritic pain stemming from Lyme disease can often look like RA. In fact, Lyme was first discovered and documented in part because of a group of children presenting with arthritis symptoms in Lyme, Connecticut.
So, if you’re experiencing joint pain, how can you tell the difference? If you’ve been bitten by a tick or think you’re at risk for a tick-borne disease, it’s extremely important not to delay seeking medical attention or ignore any arthritic pain that might be associated with Lyme disease. Continue reading to better understand the differences and similarities between Lyme disease and arthritis.
Lyme Disease: Causes and Risk Factors
Lyme disease is a tick-borne infectious disease caused by the spiral-shaped bacteria Borrelia burgdorferi sensu lato. Though Lyme is treatable with antibiotics, it can worsen, change symptoms, spread to the neurological system, become a chronic condition, and even become life-threatening if not diagnosed and treated right away.
The Centers for Disease Control and Prevention (CDC) advise physicians to consider the likelihood that a patient has been exposed to infected blacklegged ticks when screening for Lyme disease. The CDC’s risk maps highlight where Lyme disease is most common, with most cases cropping up in the Northeast and Upper Midwest of the United States. However, it’s important to note that these maps are based only on the number of reported cases of Lyme disease. Many cases of Lyme go unreported every year due to diagnostic errors and misdiagnoses, missed diagnoses, or simply lack of data.
Lyme disease occurs in all 50 states and has been found in at least 60 countries worldwide. If you’re experiencing the symptoms of Lyme disease but do not live in the Northeast or Upper Midwest, it does not mean you are not at risk for Lyme disease.
Common Symptoms of Lyme Disease
Lyme disease symptoms mimic those of many other tick-borne and non-tick related diseases, making it difficult to diagnose. Below are just some of the many ways Lyme disease may manifest, with early stage symptoms appearing anywhere from 3 days to weeks after a tick bite.
Early Lyme Disease Symptoms
- Fatigue
- Headache
- “Bull’s eye” rash, or Erythema Migrans (EM) (NOTE: Many Lyme patients do not experience a rash, so not remembering a rash does not mean you don’t have Lyme disease.)
- Fever
- Sweats
- Chills
- Muscle pain
- Joint pain
- Neck pain
- Sleep issues
Late Stage Lyme Disease Symptoms
- Fatigue
- Joint pain
- Muscle pain
- Sleep issues
- Cognitive symptoms
- Neuropathy
- Depression
- Heart irregularities
- Headaches
- Facial drooping (Bell’s Palsy)
It is not uncommon for patients presenting with arthritic pain in the knee to be misdiagnosed with Rheumatoid Arthritis.
However, one major difference between Lyme disease and arthritis is that Lyme arthritis often manifests in larger joints, and often only on one side of the body – in one knee, for example. Rheumatoid arthritis, on the other hand, occurs more often in the hands, fingers, feet, and toes, and is more often bilateral (showing up equally on both sides of the body).
Finally, Lyme arthritis is usually intermittent, while joint pain from RA usually occurs regularly every morning and tends to be chronic.
Diagnosing Lyme Disease
To diagnose Lyme disease, physicians analyze lab test results along with a patient’s physical and reported symptoms. However, as mentioned, this can be challenging due to both the wide range of disparate symptoms associated with Lyme, as well as the limitations of the blood tests themselves.
For one thing, many Lyme disease tests only detect antibodies that have developed in response to bacteria – not the bacteria itself. Since it can take some time for the body to develop enough antibodies to show up on a test, patients who are tested too early may receive negative test results but still be infected with Lyme. A patient may also test negative if they’re infected with a species of bacteria their test is not equipped to detect.
Both situations can then lead to a misdiagnosis if the patient presents with symptoms that look like another disease, such as Rheumatoid Arthritis.
Treating Lyme Disease
The only way to treat Lyme disease is with antibiotics. With timely treatment, most Lyme disease cases will clear up. However, if it is not detected early, it can lead to lifelong complications and even death. If it is misdiagnosed as Rheumatoid Arthritis, it can lead to money wasted on misguided testing and treatments as well as complications from the untreated infection, not to mention lasting damage to your health and quality of life.
Rheumatoid Arthritis: Causes and Risk Factors
Rheumatoid Arthritis is a chronic inflammatory disease affecting the lining of the joints – typically in the hands and fingers or feet and toes. Unlike with Lyme disease, the root cause of Rheumatoid Arthritis is unknown. RA is a chronic condition for which there is currently no cure.
Many consider RA to be an autoimmune disease, and it can even be a complication arising from Lyme arthritis – but not all RA stems from Lyme, just like not all arthritis is RA. While Lyme disease is a risk factor for RA and other types of inflammatory arthritis, doctors considering a diagnosis of RA will consider any of the following other risk factors for Rheumatoid Arthritis:
- A high level of IgM antibodies, called “rheumatoid factors,” resulting from an immune response that attacks healthy tissues in the body.
- The presence of anti-cyclic citrullinated peptide (anti-CPP) antibodies in the blood
- History of smoking
- Obesity
- Family history of autoimmune disease
- Occupational exposure to dust and fibers
- Genes (RA is not heritable but is linked to genetic susceptibility)
- Hormones and environmental factors, such as infections and trauma
Additionally, RA is two to three times more common in women than men.
Common Symptoms of Rheumatoid Arthritis
It’s important to understand how Lyme disease and Rheumatoid Arthritis can both overlap and differ in order to properly understand your risk for either disease. Below are some of the most common signs of early Rheumatoid Arthritis:
- Bilateral joint stiffness, especially early in the morning or after periods of inactivity
- Joint stiffness or pain in smaller joints, like the hands and fingers or feet and toes
- Swollen, tender, or warm joints
- Decreased range of motion
- Fatigue
- Weakness
- Loss of appetite
In addition to joint-related symptoms, some patients with RA have problems with the eyes, skin, heart, and lungs.
As mentioned, arthritis in one side of the body or affecting larger joints may be a sign of Lyme disease.
Diagnosing and Treating Rheumatoid Arthritis
Like Lyme disease, RA can be difficult to diagnose. There is no one blood test used to definitively rule out RA. Instead, doctors will physically examine a patient, looking for swelling, redness, or warmth in the joints as well as checking reflexes and muscle movement. They may also check the blood for the antibodies (“rheumatoid factors”) and proteins mentioned above and may even use X-rays and MRIs.
Like Lyme, Rheumatoid Arthritis can be debilitating if not treated in a timely manner. However, doctors cannot simply eliminate RA through a course of treatment – instead, they must treat symptoms over the course of a person’s lifetime. RA can cause permanent, irreversible damage to the cartilage and bones that can worsen over time without proper treatment.
The Mayo Clinic lists the most common treatments for Rheumatoid Arthritis as non-steroidal anti-inflammatory drugs (NSAIDs), steroids, and what are called conventional or biologic disease-modifying anti-rheumatic drugs (DMARDs). It is not uncommon for patients to undergo physical therapy to treat symptoms of RA, and in rarer cases or cases that do not respond to drugs or therapy, doctors may recommend surgery.
Comparing and Contrasting Lyme Disease and Arthritis
Both Lyme disease and RA can be difficult to diagnose and debilitating if not treated properly. However, misdiagnosing one for the other can be financially costly and even life-threatening. Below is a summary of the major differences between the two conditions.
| Lyme Disease | Rheumatoid Arthritis |
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The Dangers of a Misdiagnosis
Though Lyme disease is treatable, it can become disastrous if left untreated. Undiagnosed Lyme can develop into chronic Lyme, cause debilitating mental health symptoms, spread throughout the body – for example, to the neurological system or the heart – and wreak havoc on patients’ quality of life. In some cases, patients have even died from complications due to untreated Lyme.
If you believe you’re at risk for a tick-borne disease, it’s absolutely crucial not to delay treatment. Though Lyme arthritis can mimic other inflammatory arthritis symptoms like those of RA, it is a distinct infectious disease that can be eliminated if treated promptly with antibiotics. It’s important to get tested by the latest Lyme disease testing technology at a reputable center and discuss your test results with a trusted doctor.
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