Musculoskeletal symptoms in Lyme disease are very common at all stages of the disease. Lyme arthritis, whether intermittent or chronic, is a hallmark of late Lyme disease. This may cause severe joint pain and swelling especially confined to one or a few joints, most notably the knee. Antibiotic therapy is very effective in treating Lyme arthritis in the majority of cases. However, a small proportion of individuals will develop persistent chronic arthritis which is likely mediated through immunologic mechanisms. In these patients treatment strategies should include anti-inflammatory medications and possibly immunosuppressive treatments. Arthroscopic synovectomy ma ybe very helpful in some of these patients. Post Lyme disease syndrome and Lyme myositis are two other sequelae that are associated with Lyme disease.