Lyme disease is a bacterial infection caused by Borrelia burgdorferi that is transmitted through the bite of an infected blacklegged tick. If left untreated, Lyme disease can progress and lead to complications involving the nervous system, heart, and joints. There is also evidence suggesting that Lyme disease may trigger an autoimmune response in some individuals, leading to the development of autoimmune diseases.
How Lyme disease triggers autoimmunity
There are a few ways in which Lyme disease is believed to contribute to autoimmunity:
- Molecular mimicry – The bacteria that causes Lyme disease contains proteins that are similar in structure to proteins found in the body. This similarity confuses the immune system and causes it to mistakenly attack the body’s own tissues.
- Epitope spreading – The immune response to Lyme bacteria spreads to include immune reactions against other self-proteins in the body that are not related to the original bacterial protein targets.
- Bystander activation – The inflammation caused by Lyme disease activates autoreactive T cells and B cells that target self-proteins and initiate an autoimmune reaction.
- Persistent infection – Chronic Lyme disease leads to ongoing immune stimulation that may awaken dormant autoimmunity genes.
The development of autoimmunity due to Lyme disease may depend on a genetic predisposition in some individuals. Those with certain genetic markers appear to be at greater risk of developing an autoimmune disease after contracting Lyme disease.
Autoimmune diseases associated with Lyme disease
Here are some of the key autoimmune disorders that research indicates may be triggered or exacerbated by Lyme disease:
Rheumatoid Arthritis
Rheumatoid arthritis (RA) involves chronic joint inflammation and damage to the joint lining. Studies have found a higher prevalence of past Lyme disease infection in RA patients compared to the general population. The characteristic antibodies and immune cells seen in RA joints have also been found in Lyme arthritis joints, indicating similar immunopathology.
Systemic Lupus Erythematosus
Systemic lupus erythematosus (SLE) causes widespread inflammation affecting the skin, joints, kidneys, brain, and other organs. Research has found a higher level of Lyme disease antibodies in SLE patients compared to healthy individuals. There are also documented cases of SLE developing after Lyme disease.
Multiple Sclerosis
Multiple sclerosis (MS) involves damage to the protective covering of nerve fibers in the brain and spinal cord. Studies have found a greater prevalence of Lyme disease antibodies in MS patients compared to the general population. While not definitive, this suggests Lyme disease may be a causative factor in some MS cases.
Autoimmune Thyroid Disease
Autoimmune thyroid diseases, such as Graves’ disease and Hashimoto’s thyroiditis, are caused by the immune system attacking the thyroid gland. Individuals with Lyme disease have a higher rate of developing autoimmune thyroiditis compared to the general public, indicating an association.
Autoimmune Carditis
Lyme carditis, caused by Borrelia burgdorferi affecting the heart, can sometimes trigger autoimmune-mediated inflammation of the heart muscle, called autoimmune carditis. This autoimmune reaction may persist even after antibiotic treatment for Lyme disease.
Guillain-Barré Syndrome
Guillain-Barré syndrome (GBS) involves nerve inflammation that leads to muscle weakness and paralysis. Lyme disease is a known trigger for GBS. Molecular mimicry between Borrelia burgdorferi surface proteins and peripheral nerve proteins is thought to initiate the autoimmune nerve damage.
Antiphospholipid Syndrome
Antiphospholipid syndrome is characterized by blood clots and pregnancy complications. It is caused by antiphospholipid antibodies attacking proteins in the body involved in blood clotting. Case reports indicate these autoantibodies can be triggered by Lyme disease infection.
Symptoms of Autoimmune Diseases Caused by Lyme Disease
The symptoms of autoimmune diseases linked to Lyme disease can vary depending on the type of autoimmunity that develops. However, there are some general signs and symptoms that may present:
- Fatigue and weakness
- Joint pain, stiffness and swelling
- Muscle aches and pains
- Red rash on skin
- Brain fog, memory issues, and headache
- Numbness and tingling in hands and feet
- Shortness of breath, chest pain
- Abdominal discomfort, diarrhea
- Fever and enlarged lymph nodes
The autoimmune disorder caused by Lyme disease can also have specific symptoms based on the type of condition. For example:
- Rheumatoid arthritis: Swollen, warm, and painful joints – often in hands and feet. Joint deformities over time.
- Lupus: Facial rash, photosensitivity, kidney dysfunction, mouth ulcers.
- Multiple sclerosis: Vision loss, muscle spasms, impaired coordination and balance.
- Autoimmune thyroiditis: Unexplained weight changes, hair loss, feeling cold, fatigue.
- Autoimmune carditis: Chest pain, arrhythmias, shortness of breath, fluid retention.
Diagnosing Autoimmune Diseases Caused by Lyme
Diagnosing autoimmune diseases linked to Lyme disease involves testing for evidence of current or past Lyme disease infection, as well as tests specific to the suspected autoimmune disorder. Tests may include:
- Enzyme-linked immunosorbent assay (ELISA) for Lyme disease antibodies
- Western blot for Lyme disease antibodies
- Polymerase chain reaction (PCR) test for Lyme bacteria DNA
- Complete blood count, metabolic panel, erythrocyte sedimentation rate (ESR), C-reactive protein for inflammation
- Antinuclear antibodies (ANA) test for autoimmunity
- Rheumatoid factor, anti-CCP antibodies for rheumatoid arthritis
- Antiphospholipid antibodies for antiphospholipid syndrome
- Thyroid function tests for autoimmune thyroiditis
In some cases, a lumbar puncture may be done to test spinal fluid for antibodies related to central nervous system autoimmunity, such as multiple sclerosis. Imaging tests like X-rays, MRIs, and echocardiograms may also be used to evaluate damage related to autoimmune diseases possibly caused by Lyme.
Treating Autoimmune Diseases Caused by Lyme
Treatment approaches focus on killing off the Lyme bacteria with antibiotics, while also managing the autoimmune components. Typical treatments include:
- Antibiotics like doxycycline, amoxicillin, or ceftriaxone, for 4-6 weeks
- NSAIDs like ibuprofen to reduce inflammation and pain
- Corticosteroids like prednisone to suppress overactive immune response
- Disease-modifying antirheumatic drugs (DMARDs) for autoimmune arthritis
- Biologics like etanercept or rituximab that target specific parts of the immune system
- Plasmapheresis to remove antibodies from blood plasma
- Intravenous immunoglobulin (IVIG) to supply healthy antibodies
Since autoimmune diseases may persist even after antibiotic treatment, managing the autoimmune component is key. Lifestyle measures like stress reduction, an anti-inflammatory diet, exercise, and sufficient sleep can also help minimize flare-ups.
Preventing Autoimmune Diseases Caused by Lyme
The best way to prevent autoimmune diseases caused by Lyme is to avoid contracting Lyme disease in the first place through the following methods:
- Wear long sleeves and pants when going in wooded or grassy areas
- Use insect repellent with DEET on exposed skin
- Treat outdoor gear and clothing with permethrin
- Check body for ticks and shower after being outdoors
- Remove attached ticks right away using tweezers
- Keep grass cut short and create tick-safe zones in yard
- Consider prophylactic single dose doxycycline after tick bite
If Lyme disease is contracted, the key is to get diagnosed and treated with antibiotics quickly, within the first few weeks of infection, to prevent complications like autoimmunity from developing.
Conclusion
Lyme disease can trigger autoimmune diseases like rheumatoid arthritis, lupus, multiple sclerosis, thyroiditis, and antiphospholipid syndrome in some individuals. This is believed to be due to molecular mimicry between Lyme bacteria and self-proteins, as well as persistent immune system stimulation. Diagnosing and treating both the bacterial infection and autoimmune reaction is needed. Preventing Lyme disease through tick avoidance and prompt antibiotic treatment can help minimize the risk of subsequent autoimmune disease development.