Can Lyme Disease Cause Unexplained Muscle and Joint Pain?
Muscle and joint pain can occur during several stages of Lyme disease
Pain may move between joints, muscles, tendons, or other areas of the body
Lyme disease should remain in the differential diagnosis of unexplained migratory pain
Can Lyme disease cause unexplained muscle and joint pain? Yes. Lyme disease can cause muscle aches, joint pain, tendon discomfort, and pain that appears to move from one area of the body to another. In some patients, these symptoms develop before the swollen joint typically associated with Lyme arthritis appears.
After nearly four decades of treating patients with Lyme disease, I have found that many do not initially present with the swollen knee commonly associated with Lyme arthritis. Instead, they often describe pain that seems to move from one muscle or joint to another or muscle aches that are difficult to explain. This pattern does not diagnose Lyme disease by itself, but it often prompts me to include Lyme disease in the differential diagnosis, particularly when the history suggests possible tick exposure.
Many patients tell me they have seen several physicians before anyone considers Lyme disease. Their pain may migrate from one area to another, imaging studies are often unrevealing, and routine blood work may be normal. Although most unexplained muscle and joint pain is not caused by Lyme disease, Lyme disease should remain in the differential diagnosis when the clinical picture fits.
Muscle and joint pain are not unique to Lyme disease. Fibromyalgia, autoimmune disorders, thyroid disease, viral infections, neurologic conditions, orthopedic injuries, and many other illnesses can produce similar symptoms. Careful clinical evaluation is essential before attributing these symptoms to any single diagnosis.
What Does Lyme Disease Pain Feel Like?
There is no single pattern of pain that identifies Lyme disease. Patients may experience pain involving:
- muscles;
- joints;
- tendons;
- the neck or back; or
- the arms or legs.
The pain may be aching, sharp, burning, shooting, or difficult for patients to describe. It may remain in one location, involve several areas at once, or change location over time.
Some patients report that one knee hurts for several days, followed by pain in a shoulder, wrist, ankle, or another joint. Others describe generalized muscle soreness despite no recent injury or unusual physical activity.
These symptoms do not prove that a patient has Lyme disease. However, their pattern may provide important diagnostic clues when considered together with tick exposure, associated symptoms, physical examination findings, and appropriate laboratory testing.
For a broader discussion of Lyme disease manifestations, see Lyme Disease Symptoms: A Complete Guide.
Can Muscle and Joint Pain Occur During Early Lyme Disease?
Yes. Muscle aches and joint pain can occur early in Lyme disease, including during the stage when an erythema migrans rash may be present.
A review of the musculoskeletal manifestations of Lyme borreliosis cited a prospective study of 79 patients with culture-confirmed erythema migrans. Muscle pain and joint pain were each reported in 44% of patients.1
These early symptoms likely reflect the body’s response to infection and should not be confused with Lyme arthritis. A patient may experience arthralgia, meaning joint pain without objective swelling, and in some cases these symptoms can precede Lyme arthritis.
Early Lyme disease may also include:
- fatigue;
- headache;
- fever or chills;
- neck stiffness;
- swollen glands; or
- a flu-like illness.
Not every patient develops all of these findings. Some patients never recall a tick bite, and an erythema migrans rash may be absent, overlooked, hidden, or mistaken for another skin condition.
Why Can Migratory Pain Be an Important Clue?
One feature that can raise suspicion for Lyme disease is pain that migrates. Instead of remaining confined to a single injured joint or muscle, discomfort may change location over days or weeks.
A patient may describe pain in the knee one day, the shoulder several days later, and then the neck, ankle, or muscles of the legs. The discomfort may disappear from one location as it develops somewhere else.
In my practice, patients often struggle to explain this pattern. They frequently say that “everything seems to move around.” Although migratory pain is not unique to Lyme disease, I have found that this history deserves careful attention because it may distinguish Lyme disease from more localized orthopedic conditions.
Migratory pain is not specific to Lyme disease. Other infectious, inflammatory, autoimmune, and pain disorders can also produce symptoms that change location. Nevertheless, Lyme disease should be considered when migratory pain occurs together with compatible exposure or additional clinical findings.
These associated findings may include:
- fatigue out of proportion to activity;
- difficulty concentrating or brain fog;
- headaches or neck pain;
- facial weakness;
- numbness, tingling, or shooting nerve pain; or
- new swelling of a large joint.
What Is the Difference Between Joint Pain and Lyme Arthritis?
Joint pain does not necessarily mean that a patient has arthritis.
Arthralgia refers to pain in a joint without objective evidence of inflammation. Arthritis involves findings such as joint swelling, warmth, fluid accumulation, restricted motion, or inflammation detected during examination or imaging.
Lyme arthritis most often affects one or a few large joints. The knee is affected most commonly, although the ankle, shoulder, elbow, wrist, and other joints may also be involved.1
The amount of swelling can be substantial. Interestingly, some patients report less pain than might be expected given the degree of swelling.
Lyme arthritis typically develops weeks or months after an untreated infection. Earlier muscle pain and migratory joint pain should not be confused with established Lyme arthritis.
Can Lyme Disease Cause Widespread Pain?
Some patients with Lyme disease report pain involving numerous muscles, joints, or other areas of the body. Persistent symptoms following Lyme disease treatment may also include diffuse pain, fatigue, sleep disturbance, and cognitive difficulties.
These symptoms can overlap with fibromyalgia and other chronic pain disorders. A review addressing patients referred for suspected Lyme disease because of generalized musculoskeletal pain emphasized the importance of evaluating patients for both Lyme disease and alternative diagnoses.2
The overlap creates a diagnostic challenge. A patient with widespread pain should not automatically be diagnosed with active Lyme disease. Likewise, a diagnosis of fibromyalgia should not prevent clinicians from considering infectious, neurologic, rheumatologic, endocrine, or inflammatory disorders when the clinical picture warrants further evaluation.
A careful history is particularly important when symptoms began abruptly, followed outdoor exposure, or are accompanied by objective neurological findings, facial palsy, arthritis, or an erythema migrans rash.
Lyme Disease Is Only One Cause of Unexplained Pain
There are many possible causes of unexplained muscle and joint pain. Depending on the clinical presentation, physicians may need to consider:
- fibromyalgia;
- rheumatoid arthritis;
- lupus or another autoimmune disease;
- thyroid disorders;
- vitamin deficiencies;
- viral infections;
- other tick-borne diseases;
- peripheral neuropathy or radiculopathy;
- medication side effects;
- joint hypermobility disorders;
- orthopedic injuries; or
- degenerative joint disease.
Recognizing Lyme disease as part of the differential diagnosis does not mean that every patient with migratory or widespread pain has Lyme disease. The goal is to avoid both overlooking Lyme disease and attributing every unexplained symptom to Lyme disease.
When Should Lyme Disease Be Considered?
Lyme disease deserves greater consideration when unexplained muscle or joint pain occurs together with one or more of the following:
- residence in or travel to an area where infected ticks are common;
- outdoor activities associated with tick exposure;
- a known tick bite, although many patients never recall one;
- an expanding or otherwise suspicious rash;
- migratory pain;
- new neurological symptoms;
- unexplained fatigue or cognitive difficulties;
- facial palsy;
- new swelling of a large joint, particularly the knee; or
- symptoms beginning after an otherwise unexplained flu-like illness.
No single symptom confirms Lyme disease. The diagnosis depends on the complete clinical picture.
Why a Negative Lyme Disease Test May Not End the Evaluation
Laboratory testing can assist with the diagnosis of Lyme disease, but results must always be interpreted in the context of the patient’s history and timing of illness.
Antibody tests may be negative early because the immune system has not yet produced a detectable antibody response. Conversely, antibodies may remain detectable for years after a previous infection and do not necessarily indicate active disease.1
Testing is most helpful when symptoms and exposure history create a reasonable clinical suspicion for Lyme disease. Testing patients with a very low likelihood of Lyme disease increases the risk of misleading or false-positive results.
A negative test should not automatically end the evaluation if testing occurred early in the illness or clinical suspicion remains high. Likewise, a positive test should never replace a careful clinical assessment.
For a broader discussion, see Lyme Disease Test Accuracy: Why Testing Can Miss Lyme Disease.
What Should Patients With Unexplained Pain Do?
Patients with persistent, migratory, or multisite pain deserve a careful medical evaluation rather than assuming the symptoms are due to aging, stress, fibromyalgia, or Lyme disease.
The evaluation may include:
- a detailed history of symptom onset;
- the location and movement of pain over time;
- a history of tick exposure and outdoor activities;
- review of associated neurological and systemic symptoms;
- a complete physical examination;
- appropriate Lyme disease testing when clinically indicated; and
- evaluation for other infectious, inflammatory, endocrine, neurological, and musculoskeletal disorders.
Patients should also tell their physician when symptoms migrate, fluctuate significantly, or occur together with fatigue, cognitive problems, numbness, dizziness, or sleep disturbance. These details often provide important diagnostic clues.
Frequently Asked Questions
Can Lyme disease cause muscle pain without joint swelling?
Yes. Lyme disease can cause myalgia (muscle pain) and arthralgia (joint pain without objective swelling). These symptoms may occur during early Lyme disease and do not necessarily mean that Lyme arthritis has developed.
Does Lyme disease pain move around the body?
It can. Some patients experience migratory pain that changes location over days or weeks. Although migratory pain is not unique to Lyme disease, it can be an important clinical clue when accompanied by compatible tick exposure or other manifestations of Lyme disease.
Which joints are most commonly affected by Lyme disease?
Lyme arthritis most commonly affects the knee. The ankle, shoulder, elbow, wrist, and other large joints may also be involved. Lyme arthritis typically affects one or a few large joints rather than every joint simultaneously.
Can Lyme disease cause pain without a rash?
Yes. Not every patient develops or recalls an erythema migrans rash. The rash may be absent, overlooked, hidden beneath clothing, or mistaken for another skin condition. The absence of a recognized rash does not exclude Lyme disease.
Can Lyme disease cause widespread body pain?
Some patients report widespread muscle and joint pain during or after Lyme disease. However, widespread pain also occurs with fibromyalgia, autoimmune diseases, endocrine disorders, neurological illnesses, and many other conditions. A careful differential diagnosis remains essential.
Can a Lyme disease test be negative when muscle and joint pain begin?
Yes. Antibody testing may be negative early in Lyme disease before the immune system has produced a detectable antibody response. Test results should always be interpreted in light of the timing of illness and the overall clinical picture.
Does a positive Lyme test prove that unexplained pain is caused by Lyme disease?
No. Lyme disease antibodies may remain detectable for years after a previous infection. A positive test must always be interpreted together with the patient’s symptoms, exposure history, physical examination, and prior treatment.
Clinical Takeaway
Lyme disease can cause unexplained muscle and joint pain, including pain that migrates from one area of the body to another. Muscle aches and arthralgia may occur during early Lyme disease, whereas objective Lyme arthritis often develops weeks or months later if the infection is untreated.
Because muscle and joint pain are common symptoms with many possible causes, Lyme disease should be considered as part of a broad differential diagnosis rather than assumed to be the explanation in every patient. Careful attention to the history, tick exposure, associated symptoms, physical examination, and appropriate laboratory testing remains essential.
After nearly four decades of caring for patients with Lyme disease, I have found that unexplained migratory pain often deserves a closer look. Although it is not specific for Lyme disease, recognizing this pattern early may help identify patients who would otherwise remain undiagnosed.
Related Articles
Lyme Disease Pain Treatment: Managing Joint, Muscle, and Nerve Pain
Lyme Arthritis: Symptoms, Diagnosis, and Treatment
Persistent Lyme Disease: Symptoms, Diagnosis, and Treatment
Recovery From Lyme Disease
References
- Udziela S, Biesiada G, Osiewicz M, Michalak M, Stażyk K, Garlicki A, Czepiel J. Musculoskeletal manifestations of Lyme borreliosis – a review. Arch Med Sci. 2022;18(3):726-731.
- Ranque-Garnier S, Eldin C, Sault C, Raoult D, Donnet A. Management of patients presenting with generalized musculoskeletal pain and a suspicion of Lyme disease. Med Mal Infect. 2019;49(2):157-166.
Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.
Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention
