Lyme disease is an inflammatory disorder begun by receiving a bite from a tick that is infected by a bacterium. The bacterium enters the body at the spot of the tick bite, and begins to multiply and travel to different parts of the body. If untreated, it can progress to produce an infection that can take a variety of forms, but usually involves chronic inflammation affecting joints, the nervous system, the heart and the skin.

This disease has only been recognized since November 1975 when 12 children of a small rural community, Old Lyme, Connecticut, were diagnosed with juvenile rheumatoid arthritis. Nearby several other people also reported a similar type of arthritis that came on suddenly. Research was done and 51 individuals were found to have developed the same disorder in a small geographical area and at the same time of the year. Most had brief attacks of pain and swelling involving a few large joints, and many reported having noticed a peculiar, expanding, red skin area several weeks beforehand. One recalled being bitten by a tick at the site of the skin lesion. The type of rash was recognized as one that had been known to occur in Europe, where it had been associated with the bite of a sheep tick.

• There are three separate stages of Lyme disease. Each has different symptoms.
• In the first stage a skin rash may appear at the site of a tick bite. The area may feel hot to the touch, but is usually not painful. The rash grows in size over time. The rash may develop anywhere from a few days up to month after the tick bite.
• 30% of people who develop Lyme disease do not get this rash.
• Fatigue, headaches, fever, chills, aching joints and muscles, and skin sores or rashes often appear during the second stage
• In the third stage Lyme disease may spread to affect areas of the body like the heart and the nervous system.

Localized early disease stage
The onset of Lyme disease is called the localized early disease stage. If you have been infected with Lyme disease you may get a skin rash at the site of a tick bite. Common bite locations are the groin, the buttock, behind the knee or in the armpit. The rash may appear anywhere from a few days to a month after the tick has bitten. It may feel hot to the touch and is usually red around the outside with a clear centre. Beginning as a small area, it expands slowly in size over several days. It is usually not painful. Many people do not realize a tick has bitten them, and about one-third of people do not develop this rash.

Secondary stage
Within several days of the appearance of the skin lesion, many people develop symptoms and evidence of more widespread infection. This is called the secondary stage of the disease. In this stage, you could have a vague feeling of discomfort or uneasiness, feel sluggish or fatigued, get headaches, and have fever and chills. You might also have aching joints and muscles, and develop skin sores or rashes on various parts of your body.

Third stage
About 20% of people with Lyme disease have remission after the secondary stage has passed.  Most people, however, will move into the third stage of the disease. In this stage you could develop other problems that involve the heart, nervous system and joints.

The cause of Lyme disease is a spiral-shaped bacterium (spirochete) called Borrelia burgdorferi. A tick can carry this bacterium in its body, and transfer it to its host when biting through the skin. The type of tick that carries this bacterium most often bites and sucks the blood of deer, and so is called a deer tick, but it will also bite humans and any other mammals.

• Wear protective clothing to limit the access of ticks to your skin. This clothing includes long-sleeved shirts that fit tightly around the wrist and long-legged pants tucked into socks or boots.
  
• Insect repellents containing DEET can effectively repel ticks and repellents can be applied to clothing as well as exposed skin. Follow the manufacturer's instructions. Directions may vary by age.
  
• Check for ticks on clothing or attached to your skin after working in tick-infested areas. A daily total-body inspection and prompt removal of attached ticks (i.e., within 18 to 24 hours) can reduce the risk of infection.
  
• Carefully remove attached ticks using tweezers. Grasp the tick's head and mouth parts as close to the skin as possible and pull slowly until the tick is removed. Do not twist or rotate the tick and try not to damage the tick (i.e., squash or crush it) during removal.
  
• After removing ticks, wash the site of attachment with soap and water or disinfect it with alcohol or household disinfectant. 

Establishing the correct diagnosis is important, so if your doctor thinks you have Lyme disease, he or she may ask questions about your symptoms, other medical conditions, recent travel, illnesses, and contact with people who may have had infections. He or she may perform a physical examination, and look for evidence of a rash. X-rays and other tests might be ordered to find out whether the infection and inflammation is being caused by a germ. 

It is often difficult to diagnose Lyme disease because of the variation in symptoms and the course of the disease. There is also no routine definitive test to determine if Lyme disease is the cause of illness.

The main objective in the treatment of Lyme disease is to control the pain and inflammation and to eradicate the infection. Your active involvement in developing your treatment plan is essential.

Medicine

If you have Lyme disease your doctor will probably prescribe antibiotics. Depending on your symptoms the length of time you will have to take antibiotics may vary. Lyme disease is most responsive to antibiotic therapy early in the disease. However, in some people who are given antibiotics early on, the disease still progresses to later stages. Those who develop later stage Lyme disease that affects the heart or nervous system are often hospitalized and given larger amounts of antibiotics intravenously (in a liquid form, through a tube inserted directly into a blood vessel).

For mild to moderate pain associated with Lyme disease doctors often recommend acetaminophen (Tylenol^®, Panadol^®, Exdol^® , etc.). Acetaminophen is a pain reliever, but has no anti-inflammatory properties. For this reason it can usually be safely taken along with most prescription medications. However, there are daily limits of acetaminophen that can be taken, so caution should be exercised, particularly if other medications that contain acetaminophen (for example, it's found in many cold remedies) are being used. A serious overdose of acetaminophen can cause liver damage.

NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin^® , if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).  

Exercise

As the infection of Lyme disease subsides, your doctor may instruct you to do exercises that strengthen your muscles. Exercises to improve the range of motion of the joints will also assist with your ability to resume normal activities. Always consult a doctor before beginning an exercise program.

Heat/Cold

Heat or cold application can provide temporary relief of pain. Heat helps to reduce pain and stiffness by relaxing aching muscles and increasing circulation to the area. There is some concern that heat may worsen the symptoms in an already inflamed joint. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint. Applying ice or cold packs appears to decrease inflammation and therefore is the method of choice when joints are inflamed.

Protect Your Joints

Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. Three main techniques to protect your joints are:

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.

Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one.  Also, avoid keeping the same position for a long period of time.

Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls. 

Relaxation

Developing good relaxation and coping skills can give you a greater feeling of control over your Lyme disease and a more positive outlook.

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.
• The Open Forum within this Web site is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.