概述

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Lyme disease有时可以与其他条件混淆，如rheumatoid arthritis (RA)。如果未治疗，莱姆病和Ra都会变得衰弱。

When treated, Lyme arthritis symptoms usually go away. On the other hand, treatment for RA can slow the progression of the disease, but not cure it.

How can you tell which of these you have? In brief:

  • 如果你的关节炎症状是在一个关节termittent, it may be Lyme.
  • 如果你的关节炎在你身体两侧的关节中，每天早晨发生疼痛和僵硬，可能会有ra。具有ra风险因素更有可能诊断RA。

Lyme

Lyme disease has a known cause. It’s transmitted by the spiral-shaped bacteriaBorrelia burgdorferi, which is carried by blacklegged deer蜱虫。

莱姆很难诊断，因为它的广泛症状模仿了许多其他疾病的症状。

If treated early with antibiotics, it can be cured. If Lyme is undiagnosed and treated late, the symptoms can become much worse, though it’s still treatable.

RA

RA’s cause isn’t known. It’s a chronic inflammatory disease affecting the lining of your joints and is thought to be a systemicautoimmune disease。

RA results in damage to your cartilage and bone that can become progressively worse if not diagnosed and treated early. The damage is irreversible. Treatment includes anti-inflammatory drugs and sometimes antibiotics.

莱姆风险

莱姆病的基本危险因素居住在，工作，或访问有鹿和蜱的区域。

一种bout60％未经治疗的莱姆的人发育关节炎。为了most people，一旦用抗生素治疗，莱姆关节炎就会消除。但在某些情况下，莱姆关节炎没有抗生素。一 small study found that as many as one-third 患有莱姆关节炎的人对抗生素并不反应。

此外，有些人患有关节炎后睫毛炎，包括炎症性关节炎如Ra。一种2000 study估计是关于10 percentof adults with Lyme arthritis develop inflammatory arthritis that doesn’t respond to antibiotics.

The role of inflammatory antibodies in arthritis and Lyme isn’t well understood. In a 2016 French study 在最近诊断的炎症性关节炎的814人中，只有11.2％有IgM抗体，这是Ra的危险因素。

一studyfound that 10 to 20 years after Lyme arthritis,more than 50 percentof people still had positive IgM or IgG antibody responses to the Lyme bacteria.三分之一早期莱姆病的人也有阳性抗体反应在10至20年后。

Lyme as an RA risk

Once you have Lyme, it’s a risk factor for later developing RA and other types of inflammatory arthritis, such aspsoriatic arthritis (PsA)or peripheralspondyloarthritis。

In a 2016 study ， 关于 one-third of the participants who had Lyme arthritis later developed an inflammatory arthritis like RA.

If you see a Lyme rash and get treated immediately with a sufficient course of antibiotics, it’s unlikely that you’ll later have Lyme arthritis. But many people don’t see the tick, don’t have a Lyme rash, and go undiagnosed.

RA risks

Having a high level of IgM antibodies is a risk factor for RA. These presence of these antibodies, known as rheumatoid factors (RF), can result in an immune response that attacks healthy tissue. IgM antibodies are not well understood, and they are also found in people with other infections.

一种nother marker for RA is having anti-cyclic citrullinated peptide (anti-CCP) antibodies in your blood.

Specific risk factors for RA include:

  • 抽烟。This is a strong risk factor for RA, especially formore severeRA.
  • Obesity.This is especially significant in people diagnosed with RA under age 55.
  • Family history of autoimmune disease.
  • 女性。Women aretwo to three timesmore likely to develop RA than men.
  • Occupational exposure to dust and fibers.
  • 基因。RAisn’t inherited, but you may have agenetic susceptibilitythat increases your risk of developing RA.
  • Hormones.荷尔蒙和环境因素，包括感染和创伤，可能参与其中。

It’s interesting that moderate alcohol intake可能会降低风险ra。

莱姆症状

Lyme arthritis symptoms include achy, stiff, or swollen joints. Usually only one joint is affected — most often a knee. Smaller joints or tendons or bursae may also be affected. The arthritis pain may be intermittent.

Lyme has many othersymptomsin addition to arthritis. These can include:

  • an initial bull’s-eye or irregular red rash
  • 疲劳
  • 流感样症状
  • 夜汗
  • 认知能力下降
  • 诸如麻烦平衡或贝尔的麻痹等神经系统问题
  • sensitivity to light
  • cardiac disease (carditis)

RA symptoms

早期症状类风湿性关节炎包括：

  • joint stiffness on both sides of the body, especially in the morning or after inactivity
  • swollen, tender, or warm joints
  • smaller joint involvement, such as fingers and toes
  • decreased range of motion
  • 疲劳
  • 食欲不振

一种bout40 percentof people with RA have symptoms that don’t involve the joints. RA can seriously affect your eyes, skin, heart, and lungs.

Lyme RA
Joint involvement •通常仅在一侧
•Large joints involved (most often a knee)
•May impact more than one joint		 通常手，脚和手腕两侧（双边）
其他症状 模仿其他疾病的许多不同的症状 General feeling of unwellness
Diagnosis •Standard tests not always accurate
•Often done by symptoms and response to antibiotics		 可能很困难，特别是当莱姆史时
症状的持续时间 间歇性和变量 May fade and flare
疼痛 Mild to severe •Mild to severe
•Joint stiffness for more than an hour in the morning
一种ntibiotic response In most cases, symptoms respond Sometimes RA responds to antibiotics, but this isn’t understood and not FDA-approved
Infection involvement 有时蜱叮咬有繁殖 怀疑，但没有被证明
Other 如果没有治疗可能是严重的 Risk factors may include smoking, exogenous hormonal use, reproductive factors, family history of autoimmune diseases, and obesity

莱姆和莱姆关节炎

Treatment for Lyme 如果注意到蜱咬或莱姆疹，则是至少一个月的抗生素疗程。在给出抗生素后，莱姆关节炎不太可能发生。十氧环素通常是初始抗生素规定的。

莱姆关节炎有时是莱姆的第一个症状。抗生素疗程通常会清除关节炎症状。

抗生素可以口服或静脉内给药，这取决于莱姆症状的严重程度。

When Lyme arthritis occurs in the post-infection stage of Lyme, anti-inflammatory drugs such as methotrexate may be used.

RA

RA的标准处理包括抗炎药，如：

  • 非甾体抗炎药
  • conventional or biologic disease-modifying anti-rheumatic drugs (DMARDS)

Both Lyme and RA have a better outcome the sooner they are diagnosed and treated.

Lyme

大多数人没有看到初始莱姆疹，并且可能的症状的多样性使诊断困难。如果你有关节炎的症状，并且可能被蜱咬伤，请看医生排除莱姆。最好找到一个莱姆感知医生。

RA

RA also can be difficult to diagnose. If your joints regularly are stiff for an hour or more after you wake up, see your doctor. It could be RA.