Lyme Disease Misdiagnosed as Psoriatic Arthritis
Lyme disease may mimic psoriatic arthritis and dactylitis
Persistent swelling and skin findings can resemble autoimmune disease
Failure to respond to standard arthritis therapy may warrant reevaluation
A man in his 70s presented with dactylitis, nail changes, and scalp psoriasis, initially leading clinicians to diagnose psoriatic arthritis.
The patient had severe swelling of the fingers, onycholysis of the nails, and scalp psoriasis.1
However, he did not improve with corticosteroids or disease-modifying antirheumatic drugs.
“A skin biopsy was performed showing histopathological changes compatible with Lyme borreliosis and serum contained IgG antibodies against Borrelia burgdorferi,” wrote Steppat and colleagues in Rare case of Lyme borreliosis in a patient presenting with dactylitis and skin rash.1
Lyme Disease Caused Dactylitis and Arthritis
“To our knowledge, this is the first case of Lyme borreliosis describing asymmetrical dactylitis in a hand.”1
The man did not recall a tick bite but reported that his fingers first began swelling several weeks after gardening.
The authors concluded that the patient was not suffering from psoriatic arthritis but instead had Lyme borreliosis with manifestations of:
- dactylitis
- arthritis
- acrodermatitis chronica atrophicans (ACA)
Symptoms Improved After Antibiotic Treatment
After one week of penicillin, the swelling of the patient’s fingers improved.1
After six months, the arthritis, tenosynovitis, soft tissue swelling, and skin rash had completely resolved.1
Lyme Disease Can Mimic Psoriatic Arthritis
The authors emphasized that dactylitis is commonly associated with psoriatic arthritis but may also occur in Lyme borreliosis.
Furthermore, Lyme disease can occur even when there is no history of a tick bite or erythema migrans rash.
When patients fail to respond to standard psoriatic arthritis therapies, clinicians may need to reconsider the diagnosis.
“In this case, the conclusive clue was hidden in the skin biopsy,” the authors explained.1
For a broader overview, visit our Lyme Arthritis hub.
Frequently Asked Questions
Can Lyme disease be mistaken for psoriatic arthritis?
Yes. Lyme disease may mimic psoriatic arthritis with joint swelling, dactylitis, tendon inflammation, and skin findings.
What is dactylitis?
Dactylitis refers to severe swelling of fingers or toes and is commonly associated with psoriatic arthritis but may also occur in Lyme disease.
Can Lyme disease cause psoriasis-like symptoms?
Some patients with Lyme borreliosis may develop skin findings that resemble psoriasis or other inflammatory skin disorders.
What happens if psoriatic arthritis treatment fails?
Lack of improvement with corticosteroids or disease-modifying therapy may warrant reevaluation for infectious causes such as Lyme disease.
Can Lyme disease occur without a tick bite?
Yes. Many patients with Lyme disease do not remember a tick bite or erythema migrans rash.
Can antibiotics improve Lyme-related arthritis symptoms?
Yes. In this case report, symptoms improved significantly after penicillin treatment.
Clinical Takeaway
Lyme disease may imitate psoriatic arthritis with dactylitis, swelling, nail changes, tendon inflammation, and skin manifestations.
Failure to respond to standard autoimmune therapies should prompt reconsideration of infectious causes, including Lyme borreliosis.
Persistent inflammatory arthritis with atypical features may warrant Lyme disease testing and further diagnostic evaluation.
Related Articles
These related articles explore Lyme arthritis, delayed diagnosis, skin manifestations, and inflammatory joint symptoms associated with Lyme disease.
Lyme Disease Mimics Cellulitis Skin Infection
Lyme Arthritis Symptoms in Young Child Emerge Years After Tick Bite
TMJ Arthritis Triggered by Lyme Disease
Lyme Disease Misdiagnosis
Delayed Lyme Disease Diagnosis
References
- Steppat A, Skaarup Andersen N, Andreasen CM. Rare case of Lyme borreliosis in a patient presenting with dactylitis and skin rash. BMJ Case Rep. 2023;16:e253182.
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
As a Lyme literate Advocate. This is a very good share as I have read about this for years and watched a golfer suffer and treat by big pharma drugs purposely for arthritis instead of Lyme.
As one who possibly suffers from this I am encouraged that you spread the knowledge and educate on this easily mis diagnosed disease. Thank you.
I suffered with swollen hands, painful fingers. I finally started seeing a rheumatologist group. With xrays they determined I had wear and tear and said my blood didn’t carry the markers for RA but I had high inflammation and treated me for psoriatic arthritis. I took some pretty serious medicines for years. When they suggested I start using Humera, I quit seeing them. I had two friends who had developed Lymphoma. Twenty years forward in 2020 I became very sick, high fever, vomiting, chills, body aches. This was during COVID which really scared me. I also got these big round rashes all over my trunk and arms and legs. Two weeks after and the rash hadn’t gone away I went to a walk-in and being in Maine at the time, the PA took one look at me, asked me where I hurt that was new and immediately told me I had Lymes
She told me that she was prescribing 3 weeks of Doxycycline and said I’m not even going to test you yet because the tests show false negatives because it doesn’t show up for a while. I took the 3 weeks of Doxy and my wife and I started the research. Learning that sometimes more treatment is required. We found a practitioner in Maine who had been misdiagnosed as having MS when in fact it was Lymes. With the IGENIX testing it revealed I had a past infection in my life and that a new tick bite made me really sick. I had four co-infections. Its now 2023 and I’m still being treated. I lost all feeling in my legs, feet, hands. I was in bed for at least 8 months. I’ve had lots of antibiotic therapy including a pic line, Cefroxin, I’ve had neck surgery from a bad fall as my legs were getting weaker, I’ve had lots of rehab. LDN, special tinctures made by a naturalist in Maine
Its been so hard being in Florida where Lymes is never a consideration. I finally was able to convince my cardiologist to give me a pacemaker and eblation. I have had A-fib in my past and had two conversions. The 2nd conversion after open heart surgery replacing two valves and a cabbage bypass. When I got so sick in 2020 and with the very high fever my blood pressure dropped so low. Remember COVID was in its first stages. If I had gone to the hospital I would not have come out. My cardiologist was in Florida, I was in Maine. My A-fib came back and my blood pressure was all over the place. I lived with a heart rate running around 150 most of the time. I now have a heart rate around 80. I feel so much better, my cardiologist just shakes his head because he’s seen me go from an electric wheel chair, that I had to be tied in by the way, because I wasn’t able to feel my legs. I use a cane now. I still am taking certain supplements and tinctures, I still have fatigue and presently dealing with my lungs but I’ve come so far. I’m coming up on 79 and really glad to be alive. There were times though that I wished I could just have it over. The inflammation in my hands that I saw the rheumatologist for 20 years ago is gone. I don’t hurt like I used to. I’m thankful for that 2nd bite because I was getting pretty discouraged with the pain. My hand used to swell and turn red and shiny.
I have had patients who were sick for years with Lyme disease that had gone undetected until they get a tick bite or are newly infected with Lyme disease.
Hello,
I have a question about the tests being negative. I have Psoriatic Arthritis without the skin condition. I recently got tested for Lyme in a desperate attempt to get off biologics I did have tic bites when I was young, I am now 62, and my condition has steadily progressed, Psoriatic, Scoliosis, Degenerative disc, Osteoarthritis all basically at times same time. (?)
Can you please help me understand how, if my test result was negative, is there even a tiny number (amount) like .19? They only count it if it’s. 91 to 1.1 (I think 🤔). If I don’t have it, and they will not redo it, how IS THERE EVEN a SMALL number? Thank you,
Elaine Johnson
I have Lyme disease patient who never have a positive test. Patient vary in their antibody response to Lyme