It’s a fair concern. Steroids are widely used to reduce inflammation, but they come with significant risks when used during an active infection—especially Lyme disease. The conversation is often oversimplified or brushed aside.

So today, let’s break it down—in the form of a clinical dialogue.

💬 A Clinical Dialogue on Steroids in Lyme Disease

Cameron: One of my patients was prescribed steroids for joint pain—before anyone tested for Lyme. She asked me, “Could that have made things worse?”

Colleague: That happens more often than people think. Steroids are a go-to for inflammation, but they suppress the immune system.

Cameron: Exactly. And that’s the issue—if Lyme disease is active, steroids can dampen the body’s ability to fight the infection.

Colleague: So instead of helping, it may allow Borrelia to spread more deeply?

Cameron: That’s the concern. I’ve seen patients develop chronic neurologic symptoms after getting steroids without antibiotics. And the science backs it up—animal studies show worse Lyme arthritis after steroids.

Colleague: Do the guidelines address this?

Cameron: Yes, and interestingly, both IDSA and ILADS agree on this point. They each warn against using steroids before treating Lyme. IDSA advises avoiding steroids in Lyme arthritis unless antibiotics fail and the arthritis is presumed post-infectious—though that’s controversial. ILADS goes a step further, emphasizing that steroids can worsen infection if used before or without appropriate antibiotics.

Colleague: So it’s not a flat-out “never”—but it’s a big “proceed with caution”?

Cameron: Exactly. If Lyme hasn’t been ruled out, I’d never start steroids blindly. Too many patients get worse, not better.

🔬 What the Research Shows

• Animal studies (Barthold et al., 1990) show that steroids worsen Lyme arthritis when given without antibiotics

• Clinical case reports link early steroid use to worse neurologic and joint outcomes in undiagnosed Lyme

• Logigian et al., 1990 (NEJM): Patients with chronic neurologic Lyme improved with IV antibiotics—many had worsened or plateaued before diagnosis, sometimes after immune-suppressive therapies

• IDSA Guidelines (2006, 2020): Recommend avoiding corticosteroids in active Lyme arthritis unless antibiotics fail

• ILADS Guidelines (2014): Warn that steroids may exacerbate infection and recommend ruling out Lyme before starting them

🩺 Why Clinical Judgment Still Matters

• Steroids suppress immunity—and Borrelia can exploit that

• Some patients worsen dramatically after steroid exposure

• A diagnosis of autoimmune disease may be premature if Lyme is the true cause

• Both major guidelines (IDSA and ILADS) urge caution or avoidance without antibiotic coverage

✅ What I Do Instead in My Practice

• I delay steroids until Lyme is ruled out or actively treated

• I take a detailed history for tick exposure, erythema migrans, and systemic symptoms

• If Lyme is likely, I treat with antibiotics first

• I use steroids only with caution—and usually only after antibiotics have started

• I monitor closely for relapse or worsening if steroids are used

🧭 Final Thoughts

Steroids have their place—but in Lyme disease, timing matters. Giving them before identifying or treating the infection can lead to lasting harm.

Both IDSA and ILADS guidelines acknowledge the risk. That rare agreement is worth paying attention to.

I’ve seen patients whose Lyme disease was missed or dismissed—then made worse by steroids.

That’s why I always ask: What if it’s Lyme?

Treat what you see. Be cautious with what suppresses the immune system. And never let a reflex prescription override the full clinical picture.