Seeking Guidance for Rare Joint Pain: A Patient's Journey - Rare Disease

Dr. Chen Shunsheng reply Rare Disease

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Migratory joint lesions are less common in neurological diseases and may require consultation with rheumatology and dermatology.
The neurology department should rule out certain neurological infectious diseases, such as Lyme disease, which is just one of the conditions to consider.
Please consult neurology, rheumatology, and dermatology.
An introduction to Lyme disease and its neurological complications is as follows: Taiwan has long been considered free of Lyme disease; however, it has now been confirmed domestically.
After the first case of Lyme disease with neurological complications was identified, it became necessary to inform the public about the existence of this disease.
Lyme disease is an infectious arthritis caused by the spirochete Borrelia burgdorferi (B.b.), which is transmitted through the bite of the black-legged tick (Ixodes scapularis), with the white-footed mouse serving as an intermediate host.
Approximately 60% of Lyme disease patients have a history of tick bites, and the most common early symptom is chronic migratory erythema (erythema chronicum migrans, ECM).
In the acute early stage, patients may also experience flu-like symptoms, fatigue, mild fever, and generalized pain.
The complete course of Lyme disease is a multi-system inflammatory disease transmitted by the black-legged tick; its clinical features, in addition to early chronic migratory erythema, can include damage to the nervous system, heart, and joints in the mid to late stages.
In the mid to late stage, several months after onset, patients may experience abnormalities in the cardiac electrical system, neurological disorders, or arthritis.
The most common late-onset arthritis is intermittent knee arthritis, which differs from other infectious arthritis in that it does not present with septic symptoms.
Therefore, the diagnosis of Lyme disease relies on the medical history (tick bites, chronic migratory erythema, or residence in endemic areas) and clinical symptoms.
Further confirmation requires serological antibody testing; the indirect immunofluorescence assay for anti-B.
b IgG antibodies is a sensitive method for diagnosing Lyme disease, especially in patients with neurological, cardiac, and joint lesions lacking ECM, providing significant diagnostic value.
Positive antibody titers can range from 1:128 to as high as 1:2048.
In patients exhibiting neurological involvement, cerebrospinal fluid analysis may also show positive anti-B.b IgG antibodies, and some patients may have mildly elevated cerebrospinal fluid protein, with cytological examination revealing an increase in small lymphocytes or an increase in mononuclear cells with activated monocytes.
Among patients diagnosed with Lyme disease through clinical and laboratory examinations, about half will have neurological complications.
Neurological symptoms can exist independently, primarily manifesting as meningitis, cranial neuritis, radiculitis, polyneuropathy or mononeuropathy, and Guillain-Barré syndrome.
Lyme disease is primarily treated with antibiotics such as doxycycline or penicillin; early diagnosis and timely treatment lead to a good prognosis.
Lyme disease is not as rare in certain areas, as evidenced by the 16,461 reported cases to the Centers for Disease Control and Prevention in the United States, which represents increases of 26% and 41% over the previous two years.
In the United States, Lyme disease cases are most prevalent in the northeastern, north-central, and mid-Atlantic regions.
Eight states have higher incidence rates: Connecticut, Rhode Island, New York, New Jersey, Delaware, Pennsylvania, Maryland, and Wisconsin, accounting for 91% of all cases in the U.S.
No cases have been reported in Alaska, Arizona, Colorado, Montana, and South Dakota.
It has now been confirmed in Taiwan.

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Reply Date: 2006/04/01