Dr Goldman is correct in pointing out the possibility that erythema chronicum migrans may be associated with a delayed-onset arthritis. The asymmetric, monoarticular or oligoarticular arthritis may occur as long as ten months after the skin eruption, and two thirds of patients with joint involvement may have at least one recurrent attack in the following two years.1 However, our patient suffered his tick bite and eruption in June 1975, and in the following year, in which we drew convalescent serologic titers, no joint symptoms had developed.Since then, the patient reported two episodes of stiffness in the right hip, occurring one year and eight months, and 2 1/2 years after the bite. He related this to walking long distances, and he did not see a physician on either occasion. My feeling is that these symptoms were unrelated to his erythema chronicum migrans, because of the long duration
Naversen DN. Erythema Chronicum Migrans and Arthritis-Reply. Arch Dermatol. 1978;114(8):1244. doi:10.1001/archderm.1978.01640200092042
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