Archive for the ‘research’ Category

Researchers Find Method to Regrow Cartilage in the Joints

https://medicalxpress.com/news/2020-08-method-regrow-cartilage-joints.html

Researchers find method to regrow cartilage in the joints

knee cartilage

Researchers at the Stanford University School of Medicine have discovered a way to regenerate, in mice and human tissue, the cushion of cartilage found in joints.

Loss of this slippery and shock-absorbing layer, called , is responsible for many cases of and arthritis, which afflicts more than 55 million Americans. Nearly one in four adult Americans suffer from arthritis, and far more are burdened by joint pain and inflammation generally.

The Stanford researchers figured out how to regrow articular cartilage by first causing slight injury to the joint tissue, then using chemical signals to steer the growth of skeletal stem cells as the injuries heal. The work was published Aug. 17 in the journal Nature Medicine.

“Cartilage has practically zero regenerative potential in adulthood, so once it’s injured or gone, what we can do for patients has been very limited,” said assistant professor of surgery Charles K.F. Chan, Ph.D. “It’s extremely gratifying to find a way to help the body regrow this important tissue.”

The work builds on previous research at Stanford that resulted in isolation of the skeletal stem cell, a self-renewing cell that is also responsible for the production of , cartilage and a special type of cell that helps blood cells develop in . The new research, like previous discoveries of mouse and human skeletal stem cells, were mostly carried out in the laboratories of Chan and professor of surgery Michael Longaker, MD.

Articular cartilage is a complex and specialized tissue that provides a slick and bouncy cushion between bones at the joints. When this cartilage is damaged by trauma, disease or simply thins with age, bones can rub directly against each other, causing pain and inflammation, which can eventually result in arthritis.

Damaged cartilage can be treated through a technique called microfracture, in which tiny holes are drilled in the surface of a joint. The microfracture technique prompts the body to create new tissue in the joint, but the new tissue is not much like cartilage.

“Microfracture results in what is called fibrocartilage, which is really more like scar tissue than natural cartilage,” said Chan. “It covers the bone and is better than nothing, but it doesn’t have the bounce and elasticity of natural cartilage, and it tends to degrade relatively quickly.”

The most recent research arose, in part, through the work of surgeon Matthew Murphy, Ph.D., a visiting researcher at Stanford who is now at the University of Manchester. “I never felt anyone really understood how microfracture really worked,” Murphy said. “I realized the only way to understand the process was to look at what stem cells are doing after microfracture.” Murphy is the lead author on the paper. Chan and Longaker are co-senior authors.

For a long time, Chan said, people assumed that adult cartilage did not regenerate after injury because the tissue did not have many skeletal stem cells that could be activated. Working in a mouse model, the team documented that microfracture did activate skeletal stem cells. Left to their own devices, however, those activated skeletal stem cells regenerated fibrocartilage in the joint.

But what if the healing process after microfracture could be steered toward development of cartilage and away from fibrocartilage? The researchers knew that as bone develops, cells must first go through a cartilage stage before turning into bone. They had the idea that they might encourage the skeletal stem cells in the joint to start along a path toward becoming bone, but stop the process at the cartilage stage.

The researchers used a powerful molecule called bone morphogenetic protein 2 (BMP2) to initiate bone formation after microfracture, but then stopped the process midway with a molecule that blocked another signaling molecule important in bone formation, called vascular endothelial growth factor (VEGF).

“What we ended up with was cartilage that is made of the same sort of cells as natural cartilage with comparable mechanical properties, unlike the fibrocartilage that we usually get,” Chan said. “It also restored mobility to osteoarthritic mice and significantly reduced their pain.”

As a proof of principle that this might also work in humans, the researchers transferred into mice that were bred to not reject the tissue, and were able to show that human skeletal stem could be steered toward bone development but stopped at the cartilage stage.

The next stage of research is to conduct similar experiments in larger animals before starting human clinical trials. Murphy points out that because of the difficulty in working with very small mouse joints, there might be some improvements to the system they could make as they move into relatively larger joints.

The first human clinical trials might be for people who have arthritis in their fingers and toes. “We might start with small joints, and if that works we would move up to larger joints like knees,” Murphy says. “Right now, one of the most common surgeries for arthritis in the fingers is to have the bone at the base of the thumb taken out. In such cases we might try this to save the joint, and if it doesn’t work we just take out the bone as we would have anyway. There’s a big potential for improvement, and the downside is that we would be back to where we were before.”

Longaker points out that one advantage of their discovery is that the main components of a potential therapy are approved as safe and effective by the FDA.

“BMP2 has already been approved for helping bone heal, and VEGF inhibitors are already used as anti-cancer therapies,” Longaker said. “This would help speed the approval of any therapy we develop.”

Joint replacement surgery has revolutionized how doctors treat arthritis and is very common: By age 80, one in 10 people will have a hip replacement and one in 20 will have a knee replaced. But such joint replacement is extremely invasive, has a limited lifespan and is performed only after arthritis hits and patients endure lasting pain. The researchers say they can envision a time when people are able to avoid getting arthritis in the first place by rejuvenating their cartilage in their joints before it is badly degraded.

“One idea is to follow a ‘Jiffy Lube’ model of cartilage replenishment,” Longaker said. “You don’t wait for damage to accumulate—you go in periodically and use this technique to boost your articular before you have a problem.”


Explore further

Little skates could hold the key to cartilage therapy in humans


More information: Matthew P. Murphy et al. Articular cartilage regeneration by activated skeletal stem cells, Nature Medicine (2020). DOI: 10.1038/s41591-020-1013-2Deshka S. Foster et al. Elucidating the fundamental fibrotic processes driving abdominal adhesion formation, Nature Communications (2020). DOI: 10.1038/s41467-020-17883-1

Journal information: Nature Medicine , Nature Communications

Atypical Symptoms of Lyme Disease: Numbness, Paresthesia and Abdominal Wall Weakness

https://danielcameronmd.com/atypical-symptoms-of-lyme-disease-numbness-paresthesias-and-abdominal-wall-weakness/

ATYPICAL SYMPTOMS OF LYME DISEASE: NUMBNESS, PARESTHESIA AND ABDOMINAL WALL WEAKNESS

hands, elderly

Doctors are beginning to consider Lyme disease as a possible diagnosis in patients who present with unusual symptoms. This case study, published in the New England Journal of Medicine, features a patient with unique manifestations of Lyme disease. Physicians presented the case at neurology grand rounds at Massachusetts General Hospital. [1]

“A 58-year-old woman was seen in the outpatient neurology clinic of this hospital in early autumn because of hypoesthesia [numbness], paresthesia, and weakness,” writes Reda and colleagues.

Her initial symptoms began 10 weeks prior with back pain occurring between her shoulders. But the pain resolved without intervention.

Several weeks later, numbness developed in a bandlike distribution around her trunk, writes Reda from Massachusetts General Hospital and Harvard Medical School. The following week, the numbness spread, extending to her upper abdomen.

“The patient was unable to sit up from the supine position without using her arms, and she had abdominal distention,” explains Reda.

Her symptoms progressed. Paresthesia (tingling or burning sensation) developed in the third, fourth, and fifth fingers of her left hand and the fourth and fifth fingers of her right hand.

The numbness that she was experiencing extended to the genital area, causing urinary incontinence.

The woman, who lived in a wooded area of Connecticut, reported having a “small, uniformly erythematous, painless, nonpruritic rash that was consistent with the hallmark skin lesion of early Lyme disease, erythema migrans,” the authors explain.

She believed the rash, which occurred three months prior to her admittance to the hospital, was caused by an insect bite. It resolved without treatment.

Her medical history also showed hypertension, hypothyroidism, and left tibial and fibular fractures resulting from a fall, along with L4 – L5 decompression and bilateral medial facetectomy.

She also presented with diabetes with a blood glucose level of 291 mg per deciliter and a glycated hemoglobin level of 11.8% (normal less than 5.7).

There were no other identifiable causes for her symptoms, despite having an extensive evaluation.

“Her recent rash and associated risk factors for Lyme disease made Lyme radiculopathy our leading diagnosis,” the authors write.

A Lyme disease Western blot test revealed 9 out of 10 IgG bands were positive.

The woman did not need a spinal tap to confirm her Lyme disease diagnosis because, as Reda explains, “When a patient is seropositive and has a characteristic clinical syndrome for Lyme neuroborreliosis, as in this case, CSF tests for Lyme disease are unnecessary to establish a diagnosis.”

Nevertheless, a spinal tap was performed. “Direct detection of the infectious agent with CSF PCR assays is usually not possible,” the authors explain.

“CSF PCR assays for Lyme-related Borrelia are not recommended,” they state, “and a negative assay (which was present in this case) does not influence diagnostic considerations, because sensitivity of the assay is poor.”

Final diagnosis

“On the basis of the patient’s clinical features and seroreactivity, the final diagnosis was Lyme meningoradiculitis,” writes Reda.

The patient improved with a 3-week course of intravenous ceftriaxone. Although her pain diminished over the next 4 weeks, she continued to have some residual problems.

Four months after her initial treatment began, “her sensation and strength of the abdominal wall had increased such that she could contract the rectus abdominis muscles while standing,” Reda explains. “But she continued to have difficulty sitting up from the supine position.”

“The weakness of the left foot had diminished, but she still had difficulty walking on the heel,” writes Reda.

Editor’s note: The authors did not discuss the concerns some doctors have raised regarding a persistent infection. (There is no reliable test to rule out a persistent infection.)

Related Articles:

Neurologic Lyme disease presenting as abdominal pain in 71-year-old patient

Atypical findings in Lyme disease make diagnosing difficult

Case demonstrates importance of follow-up with Lyme disease patients

References:

  1. Reda HM, Harvey HB, Venna N, Branda JA. Case 34-2018: A 58-Year-Old Woman with Paresthesia and Weakness of the Left Foot and Abdominal Wall. N Engl J Med. 2018;379(19):1862-1868.

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**Comment**

In my experience, numbness, tingling, and burning are pretty common.

At least this research is honest in reporting that this woman continued to have symptoms.  It doesn’t appear like they did anything about that due to the accepted narrative that Lyme is not a chronic infection.  This is a perfect example of how research studies are not long enough to truly followup with patients over time. There also is very little on the effectiveness of extended therapy – but living examples all around who defy the research bias.

Can Lyme Disease Cause Jaundice?

https://danielcameronmd.com/can-lyme-disease-cause-jaundice/

CAN LYME DISEASE CAUSE JAUNDICE?

can lyme disease cause jaundice

Gastrointestinal complications are often seen in Lyme disease. But hyperbilirubinemia, a condition that causes yellow discoloration of the eyes and skin, referred to as jaundice, is a rare manifestation of Lyme disease. Only a handful of cases have been reported in the literature.

Two recently published case reports address the question: Can Lyme disease cause jaundice?  While it is uncommon, the authors conclude, hyperbilirubinemia can be a sign of Lyme disease, and should be considered as a differential diagnosis in patients with severe jaundice and exposure to areas endemic for Lyme disease. 1,2 

39-year-old man with fever and jaundice 

Ahmed and colleagues describe the case of a 39-year-old man who was admitted to the hospital with febrile jaundice and diffuse arthralgia.¹ He also had a fever, nausea, headaches, and a dry cough for several days.

“His serum metabolic panel was unremarkable, except for elevated total bilirubin and creatinine,” the authors write, and “common causes of hyperbilirubinemia such as hepatitis A, B, and, C were negative.”

The man did not recall a tick bite but had recently traveled to Connecticut, USA, an area endemic for Lyme disease.

“Although hyperbilirubinemia is rare in Lyme disease, it should be considered as a differential diagnosis in patients with severe jaundice and a recent history of travel,” writes Ahmed.

Doctors presumed that Lyme disease might be causing jaundice in their patient. He was started empirically on doxycycline. When Western blot test results returned, Lyme disease was confirmed and the man continued on doxycycline for treatment.

While it is rare, Ahmed et al. conclude that Lyme disease can, in fact, cause jaundice. “Lyme disease should be considered for any patient with severe jaundice, significantly in those patients who are at risk of severe infection and have recently traveled to an endemic area, regardless of the presence of a rash.”

23-year-old camper with severe jaundice 

Meanwhile, Baig et al. describe a 23-year-old man who presented to the hospital with severe jaundice, a fever of 102.02°F and diffuse arthralgia.

“He was also told he had yellowing of his eyes and skin, which prompted his visit to the Emergency Department,” Baig writes in the case report “Severe Hyperbilirubinemia: A Rare Complication of Lyme Disease.”

When all other etiologies were ruled out, the man was started on empirical doxycycline for presumed Lyme disease, which doctors believed was causing jaundice.

“Serum screening tests were predominantly negative except for a positive ELISA screen for Lyme disease, which was subsequently confirmed by Western blot,” the authors write.

As treatment on doxycycline continued, the man’s bilirubin levels steadily declined.

The authors suggest:

“Lyme disease should be considered in the differential diagnosis of hyperbilirubinemia, particularly in patients who are at risk of severe infection and end organ damage and are living in an endemic area or have recently traveled to an endemic area, regardless of the presence of a rash.”

References:
  1. Ahmed Z, Ur Rehman A, Awais A, Hanan A, Ahmad S. Lyme Disease and Severe Hyperbilirubinemia: A Rare Presentation of Lyme Disease. Cureus. 2020;12(5):e8363. Published 2020 May 30. doi:10.7759/cureus.8363
  2. Baig M, Zheng L, Farmer A. Severe Hyperbilirubinemia: A Rare Complication of Lyme Disease. Case Rep Gastrointest Med. 2019;2019:2762389. Published 2019 Dec 24. doi:10.1155/2019/2762389

 

Outdoor Warning: Ticks, Lyme Disease and 3 Poisonous Plants Increasing in Alabama

https://www.wsfa.com/2020/08/07/outdoor-warning-ticks-lyme-disease-poisonous-plants-increasing-alabama/

Outdoor warning: ticks, Lyme disease and 3 poisonous plants increasing in Alabama

The hotter and increasingly humid springs and summers are supporting a changing ecosystem
Outdoor warning: ticks, Lyme disease and 3 poisonous plants increasing in Alabama
The life stages of a blacklegged tick. (Source: WSFA 12 News/CDC)

MONTGOMERY, Ala. (WSFA) – We all know it’s very warm to simply miserably hot and humid for what seems like at least 6 months a year here in Alabama. Unfortunately, that is the perfect recipe for ticks, tick-related illnesses and poisonous plant growth.

But the number of ticks and poisonous plants has and will likely continue to rise across the state as our seasons continue to get warmer and more humid. Not only that, but the danger factor associated with both ticks and poisonous plants is also rising. That is according to scientists at Climate Central, an independent organization of scientists and journalists researching and reporting on the changing climate and its impact on the public.  (See link for article)

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**Comment**

Important quote:  

Three of the most common tick-related diseases in Alabama are Rocky Mountain Spotted Fever, ehrlichiosis and Lyme disease. According to data from UAB, total cases in Alabama for each of them have jumped rather significantly. For example, during that 8-year span Rocky Mountain Spotted Fever cases increased by a staggering 500%.

I’m glad this information is becoming available because those in the South have fought for decades to be recognized by doctors who diagnose people solely by looking at a map.  https://madisonarealymesupportgroup.com/2018/05/31/no-lyme-in-the-south-guess-again/

Correction:  Ticks are impervious to the weather.

So whatever your beliefs about global warming are – ticks simply don’t care.  They will find leaf litter or snow to hide under and come out when they darn well want to.  https://madisonarealymesupportgroup.com/2018/11/07/ticks-on-the-move-due-to-migrating-birds-and-photoperiod-not-climate-change/

What is important about this line of inquiry is that similarly to a magician’s trick to distract you from looking at what they are doing, our ‘authorities’ are experts at distracting from the important issues surrounding Lyme/MSIDS.  One of the most foundational issues surrounding this plague is our own governments’ involvement in it:  https://madisonarealymesupportgroup.com/2020/07/22/house-passes-chris-smith-measure-to-probe-if-government-turned-ticks-into-bioweapons/

https://madisonarealymesupportgroup.com/2019/07/19/biological-warfare-experiment-on-american-citizens-results-in-spreading-pandemic/

https://madisonarealymesupportgroup.com/2019/07/31/tick-expert-admits-to-working-on-ticks-dropping-them-out-of-airplanes/

Our ‘authorities’ are only too happy to get side-tracked with climate data rather than come clean on their involvement.  Dr. Fauci, the king on the NIAID throne since 1984 (interesting year, huh?), decides who gets government funding for research.  Through his position he can control the narrative and in the case of Lyme/MSIDS, he wants to continue to pigeon-hole it into an easily defined illness they can create lucrative tests, drugs, and vaccines for.  This is what they do.  They own medicine and science and are completely in bed with Big Pharma.  If you defy this accepted narrative, they will hunt you down and make your life miserable.  Many Lyme doctors have gone through this trial by fire.

Recently I posted an article about how the House just approved increased funding for Lyme:  https://madisonarealymesupportgroup.com/2020/08/02/house-approves-increased-funding-for-lyme-im-not-impressed-please-contact-congressman-pallone/

This money, unless it is watch-dogged, will end up like all the money in the past: lining the pockets of The Cabal who have clear conflicts of interest and extreme bias against Lyme patients.

This was recently seen in the TBDWG quite recently:  https://madisonarealymesupportgroup.com/2020/07/18/dr-walker-at-tbdwg-meeting-sick-patients-who-want-to-get-treated-believe-in-persistent-lyme-like-a-religion/

In essence, Walker like most on the group seriously think we believe we are ill, and if we would believe differently we would no longer be ill.

Please go into the link and contact Congressman Pallone and express that until a public hearing is held on the way Lyme has been handled (the gory back-story in full) we do not want another dime of tax-payer money going to HHS.  They need to know we are tired of their games getting us no where on our nickel.  They need to cease and desist until the truth is aired and doctors, researchers, and patients outside The Cabal are heard.  Also, contact your own representative and educate them on this so they are better equipped to make decisions.

Subacute Transverse Myelitis Caused by Borrelia Infection

https://danielcameronmd.com/subacute-transverse-myelitis/

SUBACUTE TRANSVERSE MYELITIS CAUSED BY BORRELIA INFECTION

woman with subacute transverse myelitis getting eye exam

Lyme neuroborreliosis can manifest as encephalitis or acute/subacute transverse myelitis. Only a handful of subacute transverse myelitis cases have been reported in the literature. In their article, “Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report,” Opielka et al. describe one of the few cases of subacute transverse myelitis (SaTM) associated with Lyme neuroborreliosis and involving the optic nerve.

Subacute transverse myelitis is a neurologic syndrome caused by inflammation of the spinal cord.  It can be caused by various infections, including Borrelia burgdorferi, the bacteria causing Lyme disease. Immune system disorders, vascular and other inflammatory disorders can also trigger the condition which damages or destroys myelin, an insulating substance that surrounds nerves, including those in the brain and spinal cord. ¹

It’s estimated that “transverse myelitis with infectious or parainfectious etiology accounts for 12%” of all cases, writes Opielka. Borrelia burgdorferi is one of the infectious agents known to trigger the disease. But in 40% of the cases, the cause is unknown.

Typical symptoms associated with transverse myelitis include bilateral or unilateral limb weakness, sensory disturbances, and disruption of the autonomic system. Approximately 1 in 3 patients with transverse myelitis report having a febrile illness around the onset of neurologic symptoms.

Diagnostically challenging case

The authors describe the case of a 23-year-old woman, ² who was admitted to the hospital due to hand tremors and paresthesia (burning or prickling sensation) which extended to her forearms. She did not, however, exhibit upper arm weakness.

The woman also had severe pain in the mid-cervical region and for 3 months prior, had suffered from nausea and vertigo.

Lyme neuroborreliosis presents as subacute transverse myelitis. CLICK TO TWEETShe experienced transient periods of double vision when looking at distant objects. And reportedly had a fever which lasted for 2 days several months prior to her hospital admission. She did not recall a tick bite.

“The clinical presentation of our patient was diagnostically challenging,” the authors write.

“The only indicator of a possible tick bite was an episode of raised temperature, followed by symptoms of neck stiffness and pain reported by the patient.” Furthermore, a long period of time elapsed between the onset of symptoms and hospitalization.

Tests indicate elevated intracranial pressure

Tests revealed the patient had bilateral papilloedema (optic disc swelling caused by increased intracranial pressure) and bilateral diffuse thickening of the retinal fiber nerve layer in all quadrants.

“Blurred optic margins and several flame-like peripapillary hemorrhages were observed in both eyes,” as well, writes Opielka.

Based on nerve conduction study findings, “radiculopathy of nerve roots of both peroneal nerves and the right median nerve was diagnosed. Furthermore, sensory neuropathy of both sural nerves and the right median nerve was also detected,” the authors write.

Routine blood tests were normal, but Western blot tests for Lyme disease were positive.

MRI results indicated the patient had “longitudinally extensive (> 3 segments) enlargement of the spinal cord mostly visible from C3 to C6/C7 level.”

Images also showed a hyperintense, spindle-like lesion in the central part of the spinal cord.

“An MRI of the optic nerve disclosed bilateral protrusion of the optic nerve heads, slight vertical tortuosity of both optic nerves, and bilateral hyperintense perioptic nerve sheath,” the authors explain.

“Together these signs could indicate elevated intracranial pressure,” writes Opielka.

Lyme infection triggers subacute transverse myelitis

Meanwhile, cerebral spinal fluid (CSF) tests detected antibodies against Borrelia burgdorferi (Bb). “The titers of anti-Bb IgM and IgG antibodies were significantly increased,” the authors write.

The woman was diagnosed with subacute transverse myelitis due to Borrelia burgdorferi infection. She received a 28-day course of intravenous (IV) ceftriaxone and her symptoms completely resolved.

“Our patient presented typical manifestations of [subacute transverse myelitis] SaTM with segmental swelling and enlargement of the spinal cord,” the authors write.

Additionally, she displayed another rare and frequently overlooked aspect of Lyme neuroborreliosis – optic nerve involvement.

Conclusion

“It is essential to consider [subacute transverse myelitis] SaTM when diagnosing [Lyme neuroborreliosis] LNB, especially in the endemic regions,” the authors conclude.

“Moreover, symptoms associated with optic nerve should also be considered when diagnosing patients with [Lyme neuroborreliosis] LNB.”

References:
  1. Walid MS, Ajjan M, Ulm AJ. Subacute transverse myelitis with Lyme profile dissociation. Ger Med Sci. 2008;6:Doc04. Published 2008 Jun 10.
  2. Opielka, M., Opielka, W., Sobocki, B.K. et al. Subacute transverse myelitis with optic symptoms in neuroborreliosis: a case report. BMC Neurol 20, 244 (2020). https://doi.org/10.1186/s12883-020-01816-y

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**Comment**

So thankful Dr. Cameron does these posts.

As you have seen from many of my recent posts our ‘authorities’ like Dr. Fauci push the idea of ‘Big Science’ which is large, placebo controlled double-blind studies.  Lyme/MSIDS has extremely few of those, but we do have many, many case studies.  These are not taken seriously by mainstream medicine but the information is out there for us to learn from.  When MSM finally accepts that this complex illness looks differently on everyone, perhaps they will begin accepting these smaller studies.

When I read this I couldn’t help thinking that few things cause spine stiffness, pain, and swelling but these symptoms are hallmark for Lyme disease.  I remember being barely able to twist my back to reverse my car.  The pain was excruciating.  Same with my neck which bothers me to this day and may never go back to normal.  Tremors, burning and prickling sensations are also hallmark symptoms.

The interesting thing about the cervical region, where the woman had extreme pain as well as nausea and vertigo, is that the vertebrae there differ from those in the rest of the spine in that each has openings to transport blood to the brain.  C1, also called the Atlas vertebra, supports the weight of the head.  Personally, I’ve had a lot of body work done in this area due to ongoing pain and stiffness.

Chiropractors who specialize and have a lot of extra training in this area are called Upper Cervical Chiropractors and are connected with NUCCA:  https://nucca.org It is quite different from standard chiropractic and involves no popping, twisting, or cracking. I also have trouble with my hips and by adjusting the atlas bone, my body self-adjusts all the way down eliminating my hip pain as well.  My entire family has benefitted from this treatment for different issues.  If you struggle with your neck and spine you should consider this treatment.

I’ve heard from many experienced and reputable doctors that Lyme loves the eyes:  https://madisonarealymesupportgroup.com/2020/04/15/rare-case-of-optic-neuropathy-caused-by-lyme-disease/

Lastly, I posted this some time ago for chiropractors as they may be who an undiagnosed or misdiagnosed patient sees first:  https://madisonarealymesupportgroup.com/2018/05/09/rheumatological-presentation-of-bartonella-koehlerae-henselae-a-case-report-chiropractors-please-read/  Although this is about a Bartonella infection, similar things can happen with Lyme and other coinfections.  Many patients are diagnosed by chiropractors and naturopaths who have an experienced eye and put two and two together.

Excerpt:

Please note the joint popping with each articulation and continual joint subluxation issue.  

Chiropractors need to be told about this.  Please educate!  Send them this article.