Public release date: 2-Feb-2011 [ | E-mail | Share ] Contact: Lauren Pearsonpearson@aaos.org847-384-4031American Academy of Orthopaedic Surgeons

? Early, correct diagnosis is the best way to prevent the development of Lyme arthritis in individuals with the tick-borne illness, according to a paper published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS). in patients who do develop the condition, most cases can be treated successfully with antibiotics, the review found.

“Lyme arthritis occurs commonly in patients with Lyme disease and should be considered when evaluating patients with joint complaints and who live in areas where the disease occurs,” said study author Aristides Cruz, MD, chief orthopaedic resident, Yale-New Haven Hospital. “When diagnosed early, most patients do not develop Lyme arthritis. but when correct diagnosis is delayed, arthritis can occur and requires intervention before permanent joint damage develops.”

Lyme arthritis can be defined as a painful, swollen joint, that causes a stiffness similar to osteoarthritis, and occurs most commonly in the late stages of Lyme disease, usually several months after the onset of the disease. About 60 percent of patients who are left untreated for Lyme disease in its early stages will develop Lyme arthritis, Dr. Cruz said.

“Lyme arthritis occurs when the spirochete, the bacteria that causes the disease, invades the joints and causes inflammation to the tissue that lines the joints,” he said. “If left untreated, this inflammatory response can cause the cartilage within the joints to become damaged.”

Dr. Cruz said most cases of Lyme arthritis are brief and involve a single joint, most typically the knee. The ankle, elbow, hip and wrist may also be affected, and some patients may develop a fever. Following an initial period of joint pain and swelling lasting from a week to several months, symptoms may recur until the disease is diagnosed. in the acute and late stages, Lyme disease may be difficult to distinguish from other disease processes, he added.

“Diagnosing Lyme arthritis can be problematic, especially in patients who do not report a rash and who have fever, since it can be confused with a bacterial joint infection, particularly in children,” Dr. Cruz said. “In general, the diagnosis is multifaceted and involves a thorough understanding of the common clinical and epidemiologic features of the disease, along with careful understanding of the tests used in diagnosis.”

“In most patients, Lyme arthritis can be successfully treated with oral antibiotics,” Dr. Cruz said. “Nonsteroidal anti-inflammatory drugs may also be given to help manage symptoms while the patient is improving.” A small number of patients may continue to have symptoms even after treatment with antibiotics, Dr. Cruz said. in these patients, surgical treatment may be needed to remove the diseased synovial tissue.

To help ensure a speedy diagnosis, Dr. Cruz said individuals who live in areas where Lyme disease is known to be present should look for the following symptoms and report them to their physician:

• Rash which develops near an insect bite on the skin
• Aching, redness or swelling in one or more joints especially the knee
• Fever
• Lethargy or malaise
• Headache

Dr. Cruz said that although rash occurs in the majority of patients exposed to the Lyme bacteria, in many patients who develop Lyme arthritis, the rash either never develops or goes unnoticed.

“In the classic form of Lyme disease, a rash occurs, which resembles a bull’s eye,” he said. “The fact that this rash does not always occur or is not reported in patients with Lyme arthritis makes the condition even more difficult to accurately diagnose.”

Patients who suspect they may have been exposed to ticks carrying Lyme disease should speak to their physicians about the tests used to determine if Lyme disease is present, he said.

“Lyme arthritis has an excellent prognosis with appropriate treatment,” Dr. Cruz said. “Most patients respond well to a single course of antibiotics. The key is to diagnose Lyme disease early to avoid development of arthritis, and to differentiate between Lyme arthritis and other types of arthritis in symptomatic patients.”

More about Lyme disease:

According to the Centers for Disease Control (CDC), about 30,000 cases of Lyme disease were confirmed in 2009. It occurs most commonly in the Northeast, the great Lakes region of the Midwest and in the Pacific Northwest. to help prevent Lyme disease and associated arthritis, the CDC recommends the following steps:

• Avoid wooded or bushy areas with lots of leaf litter and high grass
• Take extra precautions during may, June and July when ticks are most active
• Use insect repellent with 20 percent – 30 percent DEET on exposed skin and clothing
• Wear long pants, long sleeves, and long socks to keep ticks off your skin. Tuck pants into boots or socks and wear light-colored clothing so ticks are easier to spot
• Check your skin and clothes for ticks before going indoors

Disclosures: Dr. Smith, a co-author of this article, or an immediate family member is a member of a speakers’ bureau or has made paid presentations on behalf of and has received research or institutional support from Stryker. Another co-author, Dr. Shapiro or an immediate family member serves as a board member, owner, officer, or committee member of the American Board of Pediatrics, Sub-board on Infectious Diseases, and the American Lyme Disease Foundation.

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East Lyme – he brings his scars to the pool’s starting blocks every time he races, as well as a tattoo, “Livestrong,” on his left arm. he added the tattoo this summer.

Russell Newton doesn’t mind if you ask why.

“I say, ‘I was sick once,’” Newton said. “People don’t want to ask me about it, but it’s something that should be talked about. I got the tattoo on my arm just so I can remember it.”

Newton, a 21-year-old junior at St. Lawrence University in Canton, N.Y., and captain of the swim team, which will compete Dec. 3-4 at the Liberty League championship in Schenectady, N.Y., is now cancer-free.

But it was less than a month after his graduation from East Lyme High School, on July 7, 2007, that Newton was diagnosed with Stage 4B Hodgkin’s lymphoma, with the disease already attacking his upper body, including his lungs.

It would mean months of three-day chemotherapy sessions at Yale-New Haven Hospital, followed by radiation five days a week at Shoreline Medical Center in Guilford. Newton grew weaker. he lost feeling in his fingertips. he had to postpone his freshman year at St. Lawrence.

Yet he only remembers being really angry once, when he was trying to sign up for an on-line class at Three Rivers Community College in Norwich and thought it was unavailable. he stomped upstairs to his room and closed the door.

Other than that, he’s thought only one thing since his diagnosis.

“‘I’m not sick. I’m getting better,’” Newton said. “I never wanted to admit that I was sick.”

Newton tells the comedic version of his illness, of playing the video game Guitar Hero with his friends who came to visit him at Yale-New Haven, even going a few rounds with the game one night when he was in intensive care, where he was sent because the hospital had no other beds available.

“My friends never treated me different,” Newton said. “They made fun of me, sometimes when I didn’t want them to.

“… I wouldn’t trade what happened. it puts a different perspective on life. People say they’re having a bad day and it’s like, ‘Is it that bad a day?’ This is a second chance for me.”

????

Newton knew he wasn’t feeling well. one sign was his loss of appetite, which went from “a ton of food” to next to nothing. His times in the swimming pool were getting slower.

“Swimming was the biggest thing. I thought, ‘My sister’s starting to catch me,’” Newton said.

So he did what any normal 18-year-old would do. he punched his symptoms into the Website WebMD. it told him he had Hodgkin’s lymphoma.

“I told my parents, ‘I think I’m really sick,’” Newton said. “The whole thing was kind of comical. I wasn’t surprised when the doctor told me. I knew. … I had longer to prepare for it, I guess.”

His parents, Bill and Patricia, were stunned.

“That happens to somebody else,” Pat Newton said. “I was still pounding my head (with my hands) two weeks later saying, ‘That can’t be true.’”

Newton remembers his first chemo treatment, when the nurse came into the room with a glass container, carrying it with what looked like two oven mitts. she explained if the solution touched her skin, it would burn her.

“‘And they’re putting that in me,’” Newton recalls thinking.

When he got home, he felt stronger and was convinced that being nauseous from chemotherapy was a myth. he gorged on a chicken wrap and a salad. Soon, he didn’t feel so well.

Still, he attacked everything with the mindset he was healing and celebrated the day he could finally get back in the pool after having the chemotherapy port surgically placed under his skin.

He signed up for a masters swimming meet and competed in the 200 freestyle, standing on edge of the pool with X’s marked on his body with which to line up the radiation. he was the East Lyme school record-holder in the 200 at the time, his name on the pool’s record board.

“I kind of fell in,” Newton said, smiling. “My record was 1:48 and I swam it in 2:10. Then I couldn’t get myself out of the water because I was so tired. … I was just so happy to be in the water again.”

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The only thing that makes Newton a little bit nervous now is when he goes for a scan to make sure he is still cancer-free. It’s been nearly three years since the end of his treatments.

Still the 500-yard freestyle record-holder at East Lyme, Newton won that event at the Eastern Connecticut Conference meet as a senior in 5 minutes, 2.84 seconds. he went on to finish third at the Class M championship in 4:54.25 and was also in the top six in the state as part of a pair of relay teams. he was a member of The Day’s All-Area team and his school’s National Honor Society. he helped East Lyme coach Jack Stabach on deck during his illness.

At St. Lawrence, Newton was second last year at the Liberty League championships in the 1,650 freestyle, an event which pushes his limits of endurance and sometimes cramps his arms into pretzels. he was sixth in that event at the UNYSCSA meet which serves as the new York state championship.

In 2009, Newton’s younger sister Emily wrote an essay about her brother which earned her a $1,000 SuperSibs! Achievement Scholarship, saying it was because of him she learned what was important in life.

“My brother was diagnosed on the luckiest day of 2007, 7/7/07, and although many would see this as one of the worst days of their lives, I see it as a blessing in disguise,” Emily Newton wrote. “… my brother’s illness taught me that what’s really important is how you act in difficult situations and your ability to grow and change.”

So go ahead and ask Newton about his tattoo. he wants you to.

Much like cyclist Lance Armstrong, who was diagnosed with cancer on Oct. 2 and celebrates the day, Newton commemorates July 7.

“Every 7th I remember,” said Newton, happily eating pancakes and eggs this week, home for the Thanksgiving holiday and with truly a reason to give thanks.

“I tell all my friends, ‘This is the day I was diagnosed.’ and they say, ‘Cool, let’s go eat.’”