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There is no single laboratory marker for the diagnosis of Lyme arthritis. High levels of IgG antibodies to B. burgdorferi s.l. are found in serum from patients with Lyme arthritis, but positive serology alone is not sufficient for confirmation, especially in regions where there is high background seroprevalence. In order to substantiate a diagnosis of Lyme arthritis, alternative explanations for the arthritis should be excluded, for example osteoarthritis, trauma, spondyloarthritis, crystal-induced arthritis, and septic arthritis. Synovial fluid analysis is recommended when feasible. Granulocytic inflammation in synovial fluid is a characteristic microscopy finding, and direct detection of B. burgdorferi s.l. by culture or PCR in synovial fluid or membrane is highly supportive of a diagnosis. Lyme arthritis is sometimes accompanied by bursitis and/or enthesitis [41], and myositis has also been proven as a rare manifestation of LB [42]. Lyme arthritis is one of the rare inflammatory joint diseases in which routine laboratory parameters of inflammation, such as C-reactive protein levels and erythrocyte sedimentation rate, are often normal. Pronounced elevation of laboratory markers of inflammation in a patient with arthritis argues against Lyme arthritis.
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