Arthritis Health Center

If Lyme disease is left untreated, it may progress in stages from mild symptoms to serious, long-term disabilities. There are three stages of Lyme disease: early localized, early disseminated, and late persistent.

Stage 1: Early localized infection (1 to 4 weeks)

Some people with Lyme disease have a rash (called erythema migrans) at the site of the tick bite. The rash is usually circular and it gets larger over time. Other people don't have any symptoms in the early stages of Lyme disease and do not remember having had a tick bite. About half the people infected with Lyme disease develop a rash within 1 to 4 weeks.¹ See a picture of a Lyme disease rash .

For people who live in areas where Lyme disease most often occurs-in the United States along the Atlantic coast, the Midwest, and parts of Oregon and California-the circular rash can be a sign of Lyme disease, especially when it appears during the summer months.

Some people with Lyme disease will have flu-like symptoms with or without a rash. These symptoms may include:

• Lack of energy, which is the most common symptom.
• Headache and stiff neck.
• Fever and chills.
• Muscle and joint pain.
• Swollen lymph nodes.

In some cases of Lyme disease, the person does not notice any symptoms during this stage.

Stage 2: Early disseminated infection (1 to 4 months)

If Lyme disease is not detected and treated while early symptoms are present, or if you do not have early symptoms that trigger the need for treatment, the infection may affect the skin, joints, nervous system, and heart within weeks to months after the initial infection.

Symptoms at this stage may include:

• Being tired.
• Additional skin rashes in several places on your body that develop as the infection spreads.
• Pain, weakness, or numbness in the arms or legs.
• Inability to control the muscles of the face (paralysis of the facial nerves).
• Recurring headaches or fainting.
• Poor memory and reduced ability to concentrate.
• Conjunctivitis (pinkeye) or sometimes damage to deep tissue in the eyes.
• Occasional rapid heartbeats (palpitations) or, in rare cases, serious heart problems.

Stage 3: Late persistent infections

If Lyme disease is not promptly or effectively treated, damage to the joints, nerves, and brain may develop months or years after you become infected (late Lyme disease). Symptoms at this stage may include:

• Swelling and pain (inflammation) in the joints, especially in the knees.
• Numbness and tingling in the hands, feet, or back.
• Severe fatigue.
• Partial facial nerve paralysis, which usually occurs within the first few months after the tick bite.
• Neurologic changes, including problems with memory, mood, or sleep, and sometimes problems speaking.
• Chronic Lyme arthritis, which causes recurring episodes of swelling, redness, and fluid buildup in one or more joints that last up to 6 months at a time.

Heart, nervous system, and joint symptoms may be the first signs of Lyme disease in people who did not have a rash or other symptoms of early infection.