Dr. Roach: The link between Lyme disease and arthritis

Keith Roach
To Your Health

Dear Dr. Roach: What is known about arthritis later in life for someone who had early treatment for Lyme disease? I had it as a teenager in the late 1980s and was told by my doctor that arthritis could be an issue later. I was treated with an IV antibiotic, which I believe was the go-to treatment at the time.

— J.A.

Dear J.A.: Lyme disease, a bacterial infection transmitted by the deer tick, causes arthritis in about half of people with untreated Lyme disease. Among those who are recognized and treated early, joint and muscle pains are common, but inflammation of the joints, along with the possibility of joint damage, is unusual. So, if you were recognized and treated early, the likelihood of developing any joint problems should be no different from your risk if you had never had Lyme disease.

Lyme arthritis most commonly affects one knee, but it can affect other joints, such as the shoulder, ankle, elbow or jaw (TMJ). Eleven percent of untreated Lyme disease patients developed permanent joint damage, but only 2% developed permanent joint disability. This study comes from a time when Lyme disease frequently went unnoticed and untreated.

Diagnosing Lyme disease can be a challenge, especially when a rash has gone unnoticed or was never present at all. A doctor needs vigilance and appropriate laboratory testing to find undiagnosed Lyme disease. Conjunctivitis, damage to the nerves of the face or eyes, Lyme meningitis and abnormal electrocardiograms (including heart block) all are occasional manifestations of Lyme disease and should prompt a clinician to consider the diagnosis.

Early treatment of Lyme disease was, and is still, most commonly oral doxycycline.

Dear Dr. Roach: I just completed a bone density scan that showed that I have osteopenia. My doctor has suggested that I take both vitamin D and calcium. I read your recent column that said this can increase stroke risk, which my doctor did not tell me. I am confused that she would suggest I take vitamin D and calcium if it would increase risk of stroke.

— L.B.

Dear L.B.: Taken together, calcium and vitamin D reduce the risk of fracture in women with osteoporosis. Naturally, your doctor is concerned about your bones and wants to prevent a fracture, which can be devastating.

However, there is a substantial and growing body of literature suggesting that calcium supplements, but not dietary calcium, increase the risk of heart disease, and a new study showed an increased risk of stroke among those taking calcium supplements and vitamin D. However, there are other studies that have NOT shown an association between calcium supplements and heart attack or stroke. Experts are divided.

There is then a question of competing risks: The benefit of a decreased fracture risk you get in taking the calcium and vitamin D versus the possible harm in stroke and heart disease. Your doctor may have balanced the risk and felt the calcium was more benefit than harm. She may also be in the school that feels calcium supplements have little or no risk.

I am risk-averse for my patients and feel that, when possible, taking calcium through food, not supplements, gives the best of both worlds: reduced fracture risk without increasing the risk of heart disease and stroke. This may require a broader change in diet, which may be inconvenient to some. Calcium-fortified foods are another option.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.