Spring is the season of new life and growth, a reprieve from winter and a time that brings better weather, flowers, and newness of life.  We longed for it even here in eastern North Carolina back in the surprisingly cold and icy month of February. 

But sometimes, it is also a time of illness, of muscle and joint pain, fevers, and visits to your health care provider.

Though there are many infectious causes of springtime joint pain, fevers, and body aches in our region, tick-borne diseases carried by rickettsia (a type of bacteria) such as Rocky Mountain Spotted Fever (RMSF), and those carried by a different bacteria, Borellia, which causes Lyme disease (LD), are among the best known.  In North Carolina, the incidence of RMSF has risen since 2009, while the reported cases of LD has remained steady at about 24 cases per year.  Though not the focus of this discussion, a number of other common bacteria can also cause infectious arthritis.

There are a number of viral causes of joint pain, arthritis, and fever as well in the spring, some transmitted by secretions, coughing (such as parvovirus, Epstein-Barr virus or rubella), stool contamination (such as hepatitis A), or through intravenous or sexually transmission (hepatitis B or C and human immunodeficiency virus, HIV).  A newer viral illness to North Carolina is the Chikungunya virus, spread by mosquitoes, and first seen in Africa.

RMSF is typically spread by dog ticks in our area (usually a week or so after exposure) and can present with malaise (feeling bad), muscle pain, nausea, headache, and within a week or two, a rash (often palms or soles of feet) or arthritis (usually hands, feet, knees, shoulders).  It can be difficult to diagnose since it looks a lot like many other infections, and many times, there is no clear history of tick bite.  When untreated, it can cause severe complications such as low blood counts, delirium, or death.

LD is considered the most common vector (one living creature transmits a disease to another through a carrier) spread disease in the United States.  It is more prevalent along the East Coast and gets its name from Lyme, Connecticut, where it was first clearly described back in the 1970s.  Here the vector is usually a deer tick (“seed tick” or “black-legged tick”), much smaller than the dog ticks that spread RMSF.  Presenting symptoms are also vague, and can be missed if there is no history of tick bite, but include a localized rash that sometimes looks like an expanding red bullseye, erythema, chronic migraines.  Low-grade fevers, headache, malaise, and vague joint pain are common.  If untreated, it may progress to later stage disease which can cause chronic arthritis (often knees and wrists), nervous system involvement (depression, seizures, meningitis-like symptoms) or worse.

Viral arthritis often is seen as well with vague, non-specific symptoms such as fever, malaise, headache, muscle or joint pain.  Though many cases are self-limited and are gone within eight weeks or so, it can be tricky to diagnose, and may on occasion produce a chronic arthritis such as rheumatoid arthritis, or a severe long-term disease such as chronic hepatitis or the acquired immunodeficiency syndrome (AIDS).

Health care providers often rely upon blood testing to be sure of diagnosis.  There are specific tests for RMSF and LD, and generally specific testing for most forms of viral arthritis.  Early on in the course of diseases, these tests may be negative or non-diagnostic.  Sometimes multiple blood draws three to six weeks apart can establish the likelihood of a specific disease.  In the early 2000s, there was briefly a vaccine to prevent lyme disease, but it is no longer manufactured, reportedly due to lack of demand.

With tick spread disease, the effective therapies are directed at preventing ticks from biting, such as 20 to 30-percent deet, using permethrin on clothing, removing ticks as soon as they are seen, and keeping them off your pets.  Doxycycline is the most commonly used antibiotic for tick spread diseases, though amoxicillin, cefuroxime and others are occasionally appropriate.  Particularly in later stage disease, IV medications are appropriate.

Many viral causes of arthritis have no specific medicine or need for therapy other than supportive care with fluids, medications for pain, rest or fever.  Some, however, do have very specific therapies that can greatly reduce the duration and damage caused by the disease (such as hepatitis C, HIV).  These antiviral treatments can prevent progression and suffering in specific cases.  Also, there are vaccines for certain viruses that cause disease, such as hepatitis B, varicella (chicken pox), and rubella.

So sometimes spring fever really is an illness.  Randal E. White, M.D., FACP, FACR is a rheumatologist with Vidant Rheumatology – Washington.