Musculoskeletal manifestations are common in the second stage of the disease, and not every patient goes through that stage of the disease. It usually starts 3 to 10 weeks after the tick bite, and no more than 25% of patients develop these symptoms. When the articulations are taken by the disease, joint pain similar to inflammatory arthritis may start in a migratory polyarticular fashion. It means that not one but many different joints may start hurting at the same time, and it is not always the same articulation. After this migratory polyarticular joint problem, patients usually experience a monoarticular process, which means that the disease stays in just one articulation after a few days of migrating from one to the other.
Lyme disease affects tendons, the bursae, and other parts of the joint, and it usually involves the articulation of the knee, wrists, and ankles. In the majority of cases, these articular problems start within the first 6 months after erythema migrans appears, and they don’t usually last longer than one week. It may have a few recurrence episodes involving one joint, especially when patients do not undergo medical treatment. In other cases, stage 3 of the disease starts, and arthritis is maintained for a longer time.