Choosing Wisely:

Don’t test for Lyme disease as a cause of musculoskeletal symptoms without an exposure history and appropriate exam findings

Rationale and Comments: The musculoskeletal manifestations of Lyme disease include brief attacks of arthralgia or intermittent or persistent episodes of arthritis in one or a few large joints at a time, especially the knee. Lyme testing in the absence of these features increases the likelihood of false-positive results and may lead to unnecessary follow-up and therapy. Diffuse arthralgias, myalgias, or fibromyalgia alone are not criteria for musculoskeletal Lyme disease.
Sponsoring Organizations:
  • American College of Rheumatology
  • Sources:
  • CDC, IDSA guidelines
  • Disciplines:
  • Rheumatologic
  • References: • Guidelines and statements made by the Centers for Disease Control and Centers for Disease Control and Prevention. Lyme disease diagnosis and treatment. http://www.cdc.gov/lyme/ diagnosistreatment/index.html.
    • American College of Physicians. Guidelines for laboratory evaluation in the diagnosis of Lyme disease. Ann Intern Med. 1997;127(12):1106-8.
    • Hu LT. Lyme disease. Ann Intern Med. 2012;157(3):ITC2-1.
    • Wormser GP, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis. Clin Infect Dis. 2006;43(9):1089-134.

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