My husband has been experiencing significant joint pain and fatigue. It started with a blotchy rash on his limbs that has since gone away; the blotches were small, red, and not raised. He went to the doctor and had blood work done. Meningitis and bacterial infection have been ruled out. The doctor told him that she figured it must just be a virus and not to worry about it. I was wondering if these symptoms sound familiar to you and if so, is how should we get the appropriate diagnosis?

Question

My husband has been experiencing significant joint pain and fatigue. It started with a blotchy rash on his limbs that has since gone away; the blotches were small, red, and not raised. He went to the doctor and had blood work done. Meningitis and bacterial infection have been ruled out. The doctor told him that she figured it must just be a virus and not to worry about it. I was wondering if these symptoms sound familiar to you and if so, is how should we get the appropriate diagnosis?

Answer

The first thing that came to mind when I read your question was Lyme disease. Lyme disease was named in 1977 when arthritis was observed in a cluster of children in and around Lyme, Connecticut. Other clinical symptoms and environmental conditions suggested that this was an infectious disease, probably transmitted by an insect (an arthropod).

Further investigation revealed that Lyme disease is caused by the bacterium, Borrelia burgdorferi. These bacteria are transmitted to humans by the bite of infected deer ticks and cause more than 16,000 infections in the United States each year.

Lyme disease most often presents with a characteristic "bull's-eye" rash that expands (and is therefore called erythema migrans), accompanied by nonspecific symptoms such as fever, malaise, fatigue, headache, muscle aches (myalgia), and joint aches (arthralgia).

The incubation period from infection to onset of erythema migrans is typically 7 to 14 days but may be as short as 3 days and as long as 30 days.

Some infected individuals have no recognized illness (asymptomatic infection determined by serological testing), or have only non-specific symptoms such as fever, headache, fatigue, and myalgia. The signs of early disseminated infection usually occur days to weeks after the appearance of a solitary erythema migrans skin lesion. In addition to multiple (secondary) erythema migrans lesions, early disseminated infection may be manifest as disease of the nervous system, the musculoskeletal system, or the heart.

Early neurologic manifestations include lymphocytic meningitis, cranial neuropathy (especially facial nerve palsy), and radiculoneuritis. If your husband had any neurological symptoms it could be why he was checked for meningitis.

Musculoskeletal manifestations may include migratory joint and muscle pains with or without signs of joint swelling. The most common objective manifestation of late disseminated Lyme disease is intermittent swelling and pain of one or a few joints, usually large, weight-bearing joints such as the knee.

There are, of course, other disease processes that include a rash preceding polyarthritis. These include Reiter's syndrome and atypical rhematoid arthritis.

Even at this late stage of Lyme disease (if that is what he may have), it's easy to diagnose by measuring antibody levels in the serum. Treatment consists of antibiotic therapy, usually with tetracycline.

If arthritis continues or worsens you could question his physician about Lyme disease, as this should at least be ruled out as a possibility for his arthritic problems.