Dr. Kyle Warren
Meghan Feir Walker
The connection between lupus and Lyme disease often seems greater than it is. While both conditions cause chronic inflammation and pain and are often confused with each other, they should be handled with care. These two diseases actually cause extremely different reactions in the immune system.
So how can you determine whether you’re dealing with Lyme disease or an autoimmune disease like lupus? Read on to learn more.
What’s the Difference? Is Lyme an autoimmune condition or an infection?
First off, it’s important to know that Lyme disease is not an autoimmune condition; it’s a bacterial infection. However, it impacts the immune system in various ways. Lyme can and does exacerbate preexisting autoimmune conditions or prompt new ones to start, and it can suppress the immune system from functioning properly.
In Lyme disease, the immune system is reacting to the bacteria, and we get symptoms directly from the Lyme bacteria and symptoms from the immune system, creating inflammation, trying to fight the bug.
Lyme disease and lupus: An overview of similarities
Because of the inflammation and pain Lyme patients suffer from, their Lyme infection often gets confused with autoimmunity. However, Borrelia burgdorferi and other species of Lyme disease can cause an avalanche of chronic pain issues, inflammation, and arthritis on their own.
Lyme disease is called “the great imitator” for a reason, but there are some key indicators in immune testing that can be observed that can help you determine which kind of disease you’re dealing with and what to do about it.
Lupus is an autoimmune disease where your immune system is aberrantly attacking parts of your own body.
Lyme and lupus can look extremely similar on the surface. Both can even produce rashes. Early on in Lyme, a minority of people develop the classic Lyme bullseye rash called erythema migrans. With lupus, patients sometimes develop what’s called a malar rash, aka the butterfly rash, that can extend from one cheek to another across the nose. These rashes can be a key indicator of one condition or the other.
But beyond the rashes, it can be hard to distinguish between the two without proper testing.
For many patients, you end up with the following symptoms.
Common chronic inflammatory symptoms of both Lyme disease and lupus:
- Headaches
- Joint pain
- Muscle pain
- Difficulty recovering after a workout
- Sleep problems
- Neurological issues
- Various other problems
How to tell the difference between lupus and Lyme disease
When I have a new patient, it’s always vital to first review their history. Have they been to regular doctors? Have they seen specialists? Have they had testing done, and if so, which tests? The average Lyme patient sees 8 to 10 other doctors before they find a Lyme-literate practitioner, which means they’ve undoubtedly had some level of testing done.
When people have had previous testing done, this often includes lupus differential tests done for their general practitioner or rheumatologist. This is because people with chronic pain and inflammation issues often end up in the rheumatology or neurology departments. And if those doctors can’t find any answers, patients are often sent to a psychiatrist when they “think it’s all in your head” (as if it’s not hard enough dealing with chronic pain and other terrible symptoms every day).
When I started my career, I initially thought Lyme and autoimmune diseases like lupus would be similar, but I could not have been more wrong. While symptoms can be similar, particularly the inflammation and pain aspects, these two conditions attack and affect the immune system differently from one another. Lupus and Lyme disease have extremely distinct pathophysiologies and immune system patterns.
Diving deeper: The immune system differences between Lyme and lupus
Everyone’s immune systems have different parts that need to work together properly. Some of these white blood cells include granulocytes, lymphocytes, T cells, B cells, etc. When you get into some of these details, you find the differences between lupus and Lyme disease are extremely distinct.
With autoimmune diseases, particularly lupus, you typically have low-functioning T regulatory cells. T regulatory cells, or Tregs, are a type of cell that help control the immune system from attacking your body’s own tissues. I call them the moms of the immune system. They help keep everything else in line! When these are suppressed, autoimmunity can develop. Typically, for autoimmunity, we want to boost Treg function because it helps everything else in the immune system function properly.
Another staple of autoimmunity is overactive T helper 17 cells (Th17 cells). These make up many of your killing cells. They help kill pathogens like bacteria and fungus, but because they are pro-inflammatory, an imbalance can lead to autoimmunity.
This is the problem with autoimmunity: You are destroying your own body. Regaining control of your immune system is the only way to overcome autoimmune conditions.
However, when you’re testing the immune system of people who have chronic Lyme, we usually find a completely different pattern.
While you have an overabundance of Th17 cell activity with something like lupus, with Lyme disease, you usually have a depression of Th17 activity. There is also usually normal Treg cell function.
What almost always appears awry in a Lyme patient is the activity of your natural killer cells, white blood cells that help fight and maintain homeostasis against pathogens. Often in Lyme, you're dealing with an exhausted immune system that can't kill things. Instead of having guns to defend your home, you have pool noodles. They may make a lot of noise and create inflammation, but they’re not effective at actually getting rid of these infections. Your immune system is stuck.
Lyme bacteria and co-infections circumvent the immune system to establish a chronic infection, and they all alter the immune system in different ways.
While Lyme disease is known to throw off natural killer cell function, Bartonella aggressively interferes with Th17 cells, often in the opposite way that lupus does. Babesia is known to interfere with B cells. When you have multiple co-infections, your immune system isn’t able to function in multiple ways.
What blood tests are used to investigate Lyme or autoimmunity?
As we look at each patient with Lyme and/or co-infections, we tend to get different patterns of immune dysfunction because Lyme and each of the co-infections interferes with the immune system differently. Eventually, enough pieces of the immune system are broken to the point where it doesn't work correctly.
Because of this, the immune system becomes out of balance. The reasons why vary greatly from one patient to the next, depending on which infections and conditions each has.
In our office, this is why we order standard testing for the possibility of autoimmunity, like rheumatoid arthritis, lupus, or mixed connective tissue disease, along with thorough Lyme and co-infection panels.
In addition to these tests, I’ll also sometimes delve further and do cytokine testing or advanced lymphocyte panels that look at T cells, B cells, T helper cells, T regulatory cells, and Th17 cells to try to understand what the immune system is doing, where it’s stuck, and how we can help it.
When you go to the doctor, the standard tests for lupus look at sed rates, aka the erythrocyte sedimentation rate (ESR), and levels of C-reactive proteins (CRP). These are your classic inflammation markers. While both are often high in inflammatory conditions such as rheumatoid arthritis, lupus is distinct in that we often find the CRP normal, and the sed rate is elevated.
There are many more advanced immune system tests we can use on more difficult patients and people who are chronically ill. However, these aren’t commonly done at regular clinics yet.
We also test an ANA. If that’s positive, we can run follow-up tests because that is positive in a myriad of autoimmune disorders. The double-stranded DNA test, or DSDNA test, is the slam dunk to know whether you have lupus or not.
If you test for Lyme disease in a regular clinic, they will only test for one species of Lyme called Borrelia burgdorferi. If that immuno essay is positive, they’ll run a follow-up test called a Western blot.
We have other articles and videos on how horrible and outdated this testing protocol is, which is why in our office, we do much more thorough testing.
We run testing on 18 species of Borrelia or Lyme, not just one, along with testing multiple species of the various Lyme co-infections. Instead of one test for Babesia, we run 10. Instead of zero tests for Bartonella, we run 12. This is important because over 93% of people with chronic Lyme are also suffering from at least one co-infection.
What to do when the immune system is confused
One of the first steps in helping any autoimmune inflammatory condition is to increase your intake of omega-3 fatty acids and vitamin D. These are anti-inflammatory and can help lessen the severity of symptoms.
Treg cells are mainly housed in the gut, so when we're dealing with autoimmune diseases like lupus or rheumatoid arthritis, healing the gut becomes a primary focus. By helping improve leaky gut through an anti-inflammatory diet, you can reduce inflammation and boost Treg cell function.
Although it’s always wise to eat a healthy diet, when it comes to Lyme, diet has less of an impact. With Lyme, we're usually trying to boost the function of natural killer cells. Sugar is the sworn enemy of natural killer function. We want to incorporate things like echinacea, Andrographis, or a variety of other herbs that boost the immune system when it has run out of power.
When chronic illness doesn’t fit into one box: Dealing with autoimmunity and chronic infections like Lyme
Another important factor to keep in mind is that about 10% of patients have both Lyme and lupus. And, just to complicate things even further, you can have Lyme, multiple Lyme co-infections, and multiple autoimmune conditions going on—all at the same time. Unfortunately, this is more common than people realize, and it often leads to patients experiencing medical gaslighting.
We have cases where someone has an autoimmune disease, such as Crohn's, lupus, rheumatoid arthritis, etc., and then they get bitten by an infected tick. Tick-borne infections are known to enhance and exacerbate inflammatory conditions, so if you already have an autoimmune disease and then get Lyme disease on top of it, it can drive that inflammation.
When we deal with lupus, in particular, you want to support your joints and kidneys because lupus, in particular, attacks these areas of the body most aggressively. When they're destroyed, they're hard to repair, so it's easier to prevent the destruction in the first place, if you can.
It’s also common for a Lyme infection or a co-infection to trigger your immune system, causing you to develop autoimmune conditions.
Most of the time, it’s unclear which came first—the autoimmune condition or the tick-borne infection—because of symptom overlap and progression. Either way, if you’re dealing with multiple conditions, understanding the unique issues you’re dealing with is of utmost importance for your recovery.
When you have two or more things going on at the same time, it doesn’t mean you’re a lost cause. It just makes it more complicated to unravel and navigate. Since these various conditions affect the immune system in different ways, we need to be extremely careful in how we approach supporting the immune system. We want your immune system to fight the bug, but we don't want your immune system to further destroy your body.
Since autoimmunity and infections can be simultaneous problems, good, thorough, accurate testing is imperative. The more we know, the smoother the process will be, and the better we can help support your body.
Key takeaways
Remember, all inflammation isn’t the same, and all chronic health problems vary as well.
If you have an autoimmune condition like lupus or you have a long-term infection like Lyme, you need different strategies to support the immune system because these diseases affect different parts in varying ways.
While helping the gut heal is obviously helpful, no matter what condition you have, oftentimes, you can’t heal the gut until the root cause of the issue is fixed. While eating a gut-healthy diet is important for both autoimmune conditions like lupus and infections like Lyme, it’s usually much more helpful for managing autoimmune conditions. However, make sure you’re avoiding excess sugar intake when you have Lyme as well, since that harms natural killer cell function.
Yes, both Lyme and lupus cause inflammation and affect the immune system, but the details vary greatly from one condition to another. This is another reason why testing and individual evaluations are so important.
Each person has a unique combination of issues, whether it's Lyme and/or co-infections, Lyme and/or autoimmunity, or a combination of multiple infections and autoimmune issues. By taking a look at your history and running thorough, accurate tests, we can get a much better picture of what your body is dealing with and make an individualized plan that works for you and your healing.
Take control of your health
If you’re unsure whether you’re dealing with chronic Lyme, a Lyme co-infection, an autoimmune disease like lupus, or a combination of conditions, 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.
Discovering what your body is fighting is the first step in recovering. You can get better from Lyme, co-infections, and autoimmunity!
To learn more about Lyme disease and co-infections, check out our Lyme page and blog.
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