By Dr. Kyle Warren
Edited by Meghan Feir Walker
One of the most common autoimmune diseases, rheumatoid arthritis (RA), is thought to affect around 1.5 million adults in the US alone, with 70% of cases being women. Can Lyme disease cause rheumatoid arthritis in some of these cases?
Conventional drug therapy for RA is a combination of various painkillers and immune-suppressing drugs. While these may be necessary for some patients, we'll share some of the other factors we consider with patients in our office. This is not a comprehensive list, but rather a few things that have worked successfully for Dr. Warren's rheumatoid arthritis patients.
Keep reading to learn more about the connection between RA and Lyme and what can be done about it.
Key Takeaways:
- Lyme disease can cause joint pain and swelling that closely resembles rheumatoid arthritis, which can sometimes lead to confusion when evaluating symptoms.
- Classic rheumatoid arthritis tests often show positive RF or CCP antibodies and elevated inflammatory markers, while Lyme-related joint symptoms frequently appear with negative autoimmune testing.
- When patients are diagnosed with seronegative rheumatoid arthritis despite negative autoimmune markers, it may be important to consider whether an underlying infection, such as Lyme disease, could be contributing to symptoms.
- High-quality testing and careful evaluation help ensure that joint symptoms are being addressed at their true source so the right strategy can be pursued.
For starters, let’s just look at the official symptoms of rheumatoid arthritis.
- Morning stiffness >1 hour
- Idiopathic, non-traumatic arthritis of at least 3 joints for > 6 weeks
- Arthritis of the wrists/hands/knuckles/fingers
- Symmetric arthritis
- Rheumatoid nodules
- Positive RF factor/CCP Blood test
- Radiographic manifestations (Diagnosed via X-ray and/or MRI)
Lyme Disease vs. Rheumatoid Arthritis
| Feature | Rheumatoid Arthritis | Lyme Disease |
| Blood markers | RF or CCP often positive | Usually negative |
| Inflammatory markers | ESR/CRP often elevated | Often normal |
| Joint pattern | Symmetrical, often small joints (hands/wrists) | Migratory Joint Pain |
| Sex distribution | More common in women | Affects men and women |
Lyme disease can sometimes cause joint pain and swelling that looks very similar to rheumatoid arthritis, especially when the infection triggers chronic inflammation in the body. Because of this overlap, it is important to look closely at both symptoms and laboratory testing. In classic rheumatoid arthritis, autoimmune markers such as Rheumatoid Factor (RF) or anti-CCP antibodies are often positive, and inflammatory markers like ESR and CRP are frequently elevated. With Lyme disease, these tests are often negative or within normal ranges even when joint symptoms are present. The pattern of joint involvement can also provide clues.
When Lyme Disease Looks Like Rheumatoid Arthritis
One of the most important things to consider when evaluating joint pain is that Lyme disease can sometimes look very similar to rheumatoid arthritis. Patients with Lyme can experience joint pain, stiffness, swelling, and migrating inflammation that may resemble autoimmune arthritis, and in some cases, Lyme symptoms may even overlap with other autoimmune conditions, such as lupus. However, there are some important differences we often see in testing. In classic rheumatoid arthritis, most patients will test positive for markers such as Rheumatoid Factor (RF) or anti-CCP antibodies. In addition, inflammatory markers like ESR and CRP are often elevated because the immune system is actively attacking the joints.
With Lyme disease, these markers are frequently different. Many Lyme patients have joint symptoms that look like rheumatoid arthritis, but their rheumatoid arthritis labs, such as RF and CCP, are negative. Their inflammatory markers, like ESR and CRP, are also often normal. This is why patients are sometimes given the diagnosis of “seronegative rheumatoid arthritis.” In these situations, it becomes very important to ask whether something else could be driving the joint inflammation.
In my experience, when a patient is diagnosed with seronegative rheumatoid arthritis, but their testing does not support classic autoimmune disease, the probability of Lyme disease increases and should be considered. Rheumatoid arthritis is also significantly more common in women than in men. Because of that, when a man presents with rheumatoid arthritis-like symptoms but has negative autoimmune testing, I am always particularly suspicious of an infectious cause such as Lyme.
It is also important to note that it is possible to have both Lyme disease and autoimmune arthritis, as infections can sometimes play a role in triggering autoimmune responses in the body. In my clinical experience, this occurs in roughly 10% of patients. While it can happen, it is far less common than Lyme infection simply mimicking rheumatoid arthritis symptoms.
I would add to that list that most of my patients have hand pain and intermittent swelling when the arthritis pops up. Helping with the swelling can be overlooked in certain patients and is usually a fairly simple way to help. However, this only works if you are having pain associated with swelling.
Co-Infections: Helping Patients with RA
Rheumatoid Arthritis is an autoimmune disease where the immune system attacks the joints. Chronic infections with a virus, bacteria, or parasite can keep feeding the inflammation and perpetuate a patient’s symptoms and joint destruction.
Cytomegalovirus (CMV)
The most famous kind of viral infection is a cold or flu that you suffer from acutely, where it lasts a few days to a week or so, and then it’s done. A cold lasts a week or so and then is done. However, some viruses can stick around in a chronic state for years, causing ongoing health problems. This is especially true in patients with autoimmune diseases because their immune system isn’t functioning at 100%.
A study published in 2012 found patients with CMV and RA to have more severe joint destruction than those with RA alone[i]. Therefore, if you are still struggling with symptoms of RA, you should at least be tested for CMV.
To get rid of CMV, we use things like selenium, alpha-lipoic acid, L-glutamine, vitamin A, and vitamin D.
Bugs In the Intestines
If you have any kind of gut symptom along with your RA, like bloating, constipation, diarrhea, or heartburn, this section is likely for you.
Endolimax Nana is typically a non-pathogenic amoeba found in most people’s intestines. While it is harmless in many people, it can cause problems in patients with rheumatoid arthritis. We’ve actually known this for 30 years.
A study published in 1983 used a case study of a man who had intestinal symptoms and unresolved joint pain from RA, who was found to be positive for Endolimax Nana. Eradication of the infection cleared both his intestinal symptoms and his joint pain [ii].
What I loved most about that study is that the patient went from testing positive for rheumatoid arthritis (positive rheumatoid factor) to negative after the study. The doctors weren’t sure if the patient really had rheumatoid arthritis or if it was an infectious arthritis mimicking RA.
This concept of infections and the various bugs in your gut playing a huge role in the expression of RA has been gaining more and more traction. In 2011, a review published in Nature Reviews Rheumatology further investigated this connection between the bugs that live in your gut and rheumatoid arthritis.
“It seems that interplay between predisposing genetic factors and environmental triggers is required for disease manifestation [of RA]. New insights from DNA sequence-based analyses of gut microbial communities and a renewed interest in mucosal immunology suggest that the microbiome represents an important environmental factor that can influence autoimmune disease manifestation[iii].”
If that was Greek to you, let me translate. The “microbiome” is the collection of bugs that live in your gut. Your microbiome can be comprised of healthy or unhealthy levels of bacteria, which can play a huge role in autoimmune diseases, like RA.
Small Intestine Bacterial Overgrowth
When people ask me about the gut, most of them are worried about a “bad bug.” They ask me if they have worms, candida, H. pylori, or some other bad bug. What most people don’t consider is that oftentimes it isn’t a “bad bug” but rather your good bugs are in the wrong place and misbehaving, causing issues. You’re supposed to have probiotics/good bugs in your large intestine, but they shouldn’t be in your small intestine. When they grow more and more in the small intestine, this is called “small intestinal bacterial overgrowth,” or SIBO.
To quote Dr. Alex Vasquez: “At least 40% of rheumatoid arthritis patients have bacterial overgrowth of the small bowel, and the severity of the bacterial overgrowth correlates positively with the severity of the musculoskeletal inflammation.”
The severity of the bacterial overgrowth correlates with the musculoskeletal inflammation. That is huge! It is probably the single fact that has allowed me to help many previously unhelpable patients suffering from RA. By clearing up the gut, many rheumatoid arthritis patients see significant improvement.
The Problem with Immune Suppression
Another important consideration is that many medications used for rheumatoid arthritis work by suppressing the immune system. While these medications may be necessary in some cases, immune suppression can make it more difficult for the body to fight infections such as Lyme disease. This is one of the reasons it is so important to ensure we are addressing the correct root cause of joint symptoms.
Because Lyme disease and autoimmune arthritis can sometimes look extremely similar, especially when infections may be influencing the immune system, high-quality testing becomes essential. Making sure we correctly identify whether joint symptoms are being driven by autoimmune inflammation, infection, or a combination of both helps ensure we address the right problem. When we are targeting the correct cause, patients often have a much better chance of improving their quality of life.
Learn more about how Lyme disease can affect joint health by visiting our Lyme Disease page, or request a consultation if you would like personalized guidance.
Discover the Root Cause of Your RA Symptoms
You don’t have to live your life in pain.
If you want help discovering the root cause of your RA symptoms, reach out to our clinic and set up your free consultation with one of our team members. They will go through your history, symptoms, and next steps with you.
To learn more about Lyme disease, co-infections, autoimmunity, gut health, and more, check out our Lyme page, gut health page, and blog.
Follow Us to Learn More
If you found this information helpful, consider sharing it with friends. Don’t forget to follow us on Facebook, Instagram, and YouTube, and sign up for our weekly Restorative Health Solutions newsletter that features the topic of each week.
References
[i] Pierer M, Rothe K, Dagmar Q, Schulz A, et. al. Association of anticytomegalovirus seropositivity with more severe joint destruction and more frequent joint surgery in rheumatoid arthritis. Arthritis & Rheumatism. June 2012: 65(6) 1740-1749.
[ii] Burnsteine SL, Liakos S. Parasitic rheumatism presenting as rheumatoid arthritis. Journal of Rheumatology. June 1983: 10(3) 514-15.
[iii] Scher J, Abramson S. The Microbiome and rheumatoid arthritis. Nature Reviews Rheumatology. Oct 2011: 7; 569-578.
