Recognizing knee pain associated with Lyme disease

“In our rural health center in Maine, Lyme disease is the most common cause of acute non-injury-related knee pain and swelling, usually presenting as unilateral, red, and warm,” writes Dr. Miller in a recent letter to the American Family Practice journal. “It can also be transitory and migratory. Many patients are unaware of having had a tick bite.” [1]


Dr. Miller often treats empirically. “Because early treatment of Lyme disease decreases the chance of chronic symptoms, we often treat empirically with doxycycline while awaiting results of antibody testing. Travelers to high-risk areas may return home and develop symptoms weeks later.”


  1. Miller R. Lyme Disease As Possible Contributing Factor for Knee Pain. Am Fam Physician. 2019;100(1):4.

10 Replies to "Recognizing knee pain associated with Lyme disease"

  • Timothy Robert Wheelock
    07/03/2022 (5:11 am)

    Hello Dr Cameron, I found a tick biting me on the back of my head/neck on Thursday, June 23, then I woke up sweaty and feeling sick 2 days later. I went to the ER and was given 21 days of Doxycycline. The tick bite was very sore for a good week plus. Now, after 7 days on Doxy, I woke up on Saturday July 2 with pain in my right knee for no particular reason. I can’t sleep very well with this knee pain, no position seems to be comfortable. What do you recommend as a pain treatment? Also, should I go on intravenous antibiotics right away, continue taking the Doxy, both, or wait and see how I feel after 3 weeks? Thank you. Tim Wheelock, Gardiner Maine.

    • Dr. Daniel Cameron
      07/03/2022 (7:11 am)

      I have patients in my practice whose symptoms can flare up during treatment. I do not find antiinflammatory medications all that helpful. I have had to refer to an orthopedist to rule out another cause or to find a treatment approach. I do not typically go to IV during a flare up. The decision will have to be made by your doctors. Finally, I look for Babesia as Babesia is not treated with doxycycline.

  • Maxine A Haines
    10/30/2021 (6:49 pm)

    I have IGG 41, 23 32. I couldn’t put my foot down. Now I’m limping in constant pain. Hip and back MRI fine. I’m going for a knee MRI. I had Lyme 3 times. But this is old Lyme. But says reactive. My doctor put me on doxycycline. Its been day 2 no real improvement.
    Is it Lyme? I’m in constant knee pain.

    • Dr. Daniel Cameron
      10/31/2021 (7:52 am)

      There are so many causes of knee and foot pain. The bands could be left over from an earlier illness with Lyme disease. I advise my patients to also look for underlying knee problems. I have some patients with knee problems that are exacerbated by Lyme disease. BTW I do not see gains in 2 days.

  • Mary
    11/27/2020 (11:02 am)

    I developed side of knee pain diagnosed as MCL sprain and substituted walking for my usual running but when pain persisted and got worse and seemed to spread all around knee with difficulty bending after two months, had an MRI, which showed MCL and ACL sprains, torn meniscus, bone contusions, partly ruptured Baker’s cyst, chondromalacia and bursitis in two places. Blood work showed Lyme antibodies (but had LymeRix 20 years ago) and presence of 4 rather than required 5 Borrelia bands so was deemed inconclusive. Took doxy for 30 days and finished about 5 weeks ago. Knee slightly better but still hurts. Did I have Lyme? No other symptoms except skin abnormalities (not rash). What to do next? BTW– my husband was also diagnosed with Lyme about a month before my knee problems began and is recovered after doxy. We are in NJ.

    • Dr. Daniel Cameron
      11/27/2020 (3:37 pm)

      I find it more difficult to diagnose Lyme disease in my patients if there are only a few symptoms.  I am not sure how many bands persist after the LymeRx vaccine.  The 31 and 34 bands were not included in the current test as they are often positive from LymeRx.  I have to use clinical judgement.

  • Marie
    11/24/2020 (10:18 am)

    Hello. I feel pain in both knees for several months and I was bitten in May. Would that be possible that it is Lyme or is it always only one knee?

    • Dr. Daniel Cameron
      11/24/2020 (2:03 pm)

      I have often seen patients in my practice with both knees affected.

  • charlie
    07/27/2020 (1:45 pm)

    was bitten in May. experiencing knee pain in right knee that came on sudden and has not gone away. Could it be related Dr. Cameron?
    How would I explain to owcp that it May be connected? Are Lymes blood tests accurate? – Charlie

    • Dr. Daniel Cameron
      07/27/2020 (2:00 pm)

      I often see knee pain early in Lyme disease. The tests are not as reliable as I would like.

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