Review: Unraveling Lyme Disease

Lyme disease, caused by spirochetes of the Borrelia burgdorferi sensu lato complex (hereafter referred to as Lyme borrelia), is the most common tick-borne infection in the northern hemisphere (1). The potential for the infection to cause arthritis led to its recognition as a clinical entity in 1975 (2), and since then, the number of reported cases has steadily increased in the United States and elsewhere. The Centers for Disease Control and Prevention (CDC) estimates the annual case incidence of Lyme disease in the United States is ~300,000, ten-fold more than the number reported by physicians. This review is intended to provide rheumatologists with a current understanding of North American Lyme disease, with emphasis on arthritis pathogenesis and expected outcomes from treatment.