Physicians and researchers have made important discoveries about the connections between Lyme disease and autoimmune diseases. While more research is still needed, the existing evidence can be useful for both physicians and patients in understanding and treating their symptoms.
In this article, we’ll cover some basic information on autoimmune diseases, how Lyme disease may trigger them, and how the similarities between the symptoms of Lyme and symptoms of some autoimmune diseases can lead to a missed or misdiagnosis.
What is an autoimmune disease?
An autoimmune disease is just one type of immune system disorder. Immune system disorders are disorders that cause the immune system to have abnormally high or abnormally low activity levels. An autoimmune disease falls into the former category, causing the immune system to become overactive and attack and damage the body’s own tissues.
There are at least 60-100 autoimmune diseases affecting about 50 million Americans, mostly women. Some of the most common include:
- Lupus
- Scleroderma
- Type 1 diabetes
- Rheumatoid arthritis
- Psoriasis
- Alopecia
- Thyroid disease
- Addison’s disease
- Pernicious anemia
- Celiac disease
- Inflammatory bowel disease
Some experts also consider chronic fatigue syndrome to be an autoimmune disorder.
Autoimmune disease vs. systemic autoinflammatory disease (SAID): Understanding the immune system
Autoimmune diseases are not the only type of immune system disorder associated with immune system overactivity. A newer, less recognized category is that of systemic autoinflammatory diseases, or SAIDs. Though they share many symptoms, they actually arise from two different immune systems: the innate immune system and the adaptive immune system.
Autoimmune diseases are disorders of the adaptive immune system, which works by creating specialized antibodies to attack specific antigens. The cells involved in these processes are B-cells or T-cells. Vaccines work by utilizing the adaptive immune system, introducing pathogens (such as the COVID-19 virus) to the body so that it will create the specific antibodies needed to fight off that pathogen. This system is also engaged to fight off bacterial infections like Lyme and other tick-borne diseases.
The other immune system is what is known as the innate immune system. This is the immune system affected by SAIDs. The innate immune system is the immune system you’re born with, consisting of all the physical barriers (e.g., skin, hair, mucus membranes), defense mechanisms (both passive, e.g., skin and hair, and active, e.g., coughing, sneezing, and fevers), and general immune responses (i.e., tagging harmful foreign invaders for destruction) that protect the body from illness. One of the primary forms of general immune responses is inflammation – the process of sending immune cells to the site, which will swell as the immune cells (leukocytes) go about attacking harmful agents.
The main difference between the innate immune system and the adaptive immune system is that the innate immune system provides general defense, whereas the adaptive immune system creates specialized cells to fight specific foreign agents.
Both autoimmune diseases and SAIDs cause the body to attack itself. However, SAIDs are disorders of the innate immune system, causing inflammatory responses that do not involve antibodies, whereas autoimmune disorders are disorders of the adaptive immune system, causing the body to create antibodies that recognize, remember, and continually fight off cells from a specific body system, such as the joints (as in rheumatoid arthritis) or the skin (as in psoriasis).
Autoinflammatory disorders and autoimmune disorders can share several symptoms, including inflammation, swollen lymph nodes, rashes, and fevers. (Note that some of these are also common symptoms of tick-borne diseases such as Lyme.) This article will focus primarily on autoimmune diseases and how they mimic, differ from, and interact with Lyme disease, although researchers have documented at least one case of a SAID – adult on-set Still’s disease, or AOSD – that was apparently precipitated by Lyme disease.
What causes autoimmune diseases?
Most experts agree that autoimmune diseases are caused by environmental triggers. Common examples include foods (e.g., gluten products), toxins (from hair dyes, tobacco products, and more), and viral or bacterial infections.
Indeed, there is growing evidence that Lyme disease and other bacterial infections can trigger autoimmune diseases, especially in patients who are genetically predisposed to them. Studies have documented several cases of Lyme disease that appeared to trigger or mimic autoimmune diseases, including Sjogren’s syndrome, dermatomyocitis (DM), rheumatoid arthritis (RA), psoriatic arthritis (PsA), and spondyloarthritis (SpA).
Autoimmune diseases and Lyme disease: Misdiagnosis or complication of Lyme?
As mentioned above, there are documented correlations between Lyme and autoimmune diseases. The evidence shows that Lyme disease may trigger (or manifest as) an autoimmune disease, or it may mimic an autoimmune disease.
What does this mean for patients and physicians? It comes down to the importance of getting an accurate and timely diagnosis if you suspect Lyme or another tick-borne disease. The longer Lyme disease goes untreated, the stronger the chance that it will spread to multiple body systems and possibly trigger an autoimmune response.
Because Lyme disease symptoms mimic symptoms of so many other conditions, including autoimmune diseases, it is notoriously tricky to diagnose. One of the most common Lyme disease misdiagnoses is the autoimmune disease rheumatoid arthritis (RA), characterized by chronic joint pain.
If a patient with Lyme is diagnosed with RA without the Lyme being detected and treated, not only can the arthritic symptoms of Lyme persist and worsen, but the Lyme can also go on to affect more systems, causing neurological and psychiatric symptoms, heart problems, and more. In rare cases, untreated Lyme can even be fatal.
Early detection is key
Avoiding a Lyme disease misdiagnosis and possible complications depends on timely, accurate testing. Lyme disease should not be discounted in patients presenting with autoimmune disease-like symptoms, even if the patient doesn’t remember a tick bite or rash. Even if the patient has a history of or genetic predisposition to autoimmune disorders, the presence of such a disorder doesn’t rule out Lyme disease.
But diagnosing Lyme disease requires more specific, sensitive testing than is typically recommended by the CDC, especially at later stages of the disease. Learn why IGeneX tick-borne disease tests are different.
