'Water on the knee' could be early sign of Lyme disease

November 01, 2015

ROSEMONT, Ill.--Spontaneous knee effusion, also known as "water on the knee," can be a primary symptom of Lyme disease, even when patients do not exhibit a "bull's eye" rash, another common Lyme disease symptom. According to a literature review appearing in the November issue of The Journal of the American Academy of Orthopaedic Surgeons (JAAOS), early diagnosis and antibiotic treatment can prevent the development of Lyme disease's more severe symptoms.

Lyme borreliosis, or Lyme disease--the most common vector-borne illness transmitted by insects--is prevalent in the Northeast and upper Midwest regions of the United States. Over 30,000 cases are reported to the Centers for Disease Control and Prevention (CDC) each year and likely over 300,000 new cases occur but go unreported.

"It is important to catch and treat Lyme disease early because the symptoms get progressively worse over time," said Elizabeth Matzkin, MD, lead study author and assistant professor of orthopaedic surgery at Harvard Medical School. "However, the lab tests used to diagnose Lyme disease can take time to process, and there are certain circumstances in which immediate antibiotic treatment may be recommended before the lab results are complete." If symptoms have been present for less than two weeks, the Lyme test may need to be repeated as the test can remain negative the first two weeks of an infection.

The current standard of care for the diagnosis of Lyme disease is a two-tier blood test. Antibiotic treatments are successful in 99 percent of patients who are diagnosed early and in 90 percent of patients who are diagnosed later. If left untreated, 60 percent of patients eventually develop Lyme arthritis, with the most severe cases having higher risks of permanent joint damage.

"Half of patients do not recall a tick bite or observe a rash, and early symptoms are not always detected when a physician diagnoses a knee effusion," said Dr. Matzkin. "One of the most notable differentiating factors is, while septic or arthritic knees usually come with significant pain, knee effusions caused by Lyme disease are often very large, not activity-related, and mostly pain-free."

Early symptoms of Lyme disease, which include fatigue, chills, fever, headache, muscle and joint aches, and swollen lymph nodes, occur three to 30 days after exposure and are not always present.

In areas where Lyme disease is common, physicians should always consider whether a spontaneous knee effusion might be caused by the disease and test accordingly. In areas of low prevalence, the clinician should ask if the patient has traveled to such an area before making a diagnosis.
-end-
More information about the AAOS

Disclosures: Dr. Matzkin or an immediate family member has received research or institutional support from Zimmer. Neither of her co-authors nor any immediate family member has received any form of compensation for their research on this topic.

American Academy of Orthopaedic Surgeons

Related Lyme Disease Articles from Brightsurf:

Cracking the Lyme disease code
The next time a tick feeds on you, Washington State University researchers hope to make sure persistent arthritis caused by Lyme disease doesn't linger for a lifetime.

Many lyme disease cases go unreported; A new model could help change that
A new model based on 17 years of data can help predict the trajectory of where Lyme disease will spread.

Ethnobotanical medicine is effective against the bacterium causing Lyme disease
A preclinical in vitro study shows that selected plant-based herbal medicines, especially Ghanaian quinine and Japanese knotweed, work better than antibiotics against the bacterium that causes Lyme disease.

Paper-based test could diagnose Lyme disease at early stages
After a day hiking in the forest, the last thing a person wants to discover is a tick burrowing into their skin.

Lyme disease claim lines increased 117% from 2007 to 2018
From 2007 to 2018, claim lines with diagnoses of Lyme disease increased nationally 117%.

New effective vaccines for Lyme disease are coming
There is no effective vaccine currently available to prevent Lyme disease in humans.

New test diagnoses Lyme disease within 15 minutes
Current testing for Lyme disease, called the standard 2-tiered approach or the STT, involves running two complex assays (ELISA and western blot) to detect antibodies against the bacterium, and requires experienced personnel in a lab, and a few hours to carry out and interpret.

An innovative new diagnostic for Lyme disease
In new research, Joshua LaBaer, executive director of the Biodesign Institute at Arizona State University and his colleagues describe an early detection method for pinpointing molecular signatures of the disease with high accuracy.

Mouse, not just tick: New genome heralds change in Lyme disease fight
As Lyme disease increases, researchers have taken a significant step toward finding new ways to prevent its transmission.

Breakthrough paves way for new Lyme disease treatment
Virginia Tech biochemist Brandon Jutras has discovered the cellular component that contributes to Lyme arthritis, a debilitating and extremely painful condition that is the most common late stage symptom of Lyme disease.

Read More: Lyme Disease News and Lyme Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.