Differentiating Lyme arthritis: a case-based review

Ayse Mine Unlu*, Nanna Skaarup Andersen, Sanne Løkkegaard Larsen, Sigurdur Skarphedinsson, Stavros Chrysidis, Fredrikke Christie Knudtzen, Philip Rask Lage-Hansen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review


The incidence or prevalence of Lyme arthritis (LA) in Denmark is unknown and assumed very low. No published cases of polymerase chain reaction (PCR)-confirmed LA from Denmark exist. Clinically, LA does not differ from other rheumatic oligoarthritic disorders posing a differential diagnostic challenge. To review the incidence and prevalence of LA to our knowledge and to present a case series of PCR-confirmed LA cases from Denmark. We conducted a systematic literature review via MEDLINE and EMBASE to explore incidence and prevalence rates of LA. Additionally, we present six cases of patients diagnosed with LA in Denmark. Our literature review identified 23 studies reporting prevalence or incidence, yet only ten studies provided estimates ranging from 1.1 to 280/100.000 in the general population. Our case series identified six patients with LA from a localized region in Southern Denmark; all confirmed by Borrelia-specific real-time PCR from synovial fluid. The diagnostic delay was up to 38 months. All patients except one had a history of previous tick bites; none had erythema migrans lesions. All presented with recurrent arthritis in the knee joint, and two had arthritis in the wrist. The literature review showed an incidence of LA ranging from 1.1 to 15.8 per 100.000 in Europe. Our case series suggests a potentially higher prevalence of LA in Denmark than previously believed. Lack of tick exposure history, antibody assessments and test of Borrelia burgdorferi sensu lato DNA in synovial fluid might lead to misdiagnosed cases potentially explaining the assumed low incidence of LA in Denmark.

Original languageEnglish
JournalRheumatology International
Publication statusE-pub ahead of print - 2024


  • Arthritis, infectious
  • Borrelia burgdorferi sensu lato
  • Case reports
  • Europe
  • Lyme disease


Dive into the research topics of 'Differentiating Lyme arthritis: a case-based review'. Together they form a unique fingerprint.

Cite this