Lyme disease is a multi-system inflammatory disease caused by spirochetes of the Borrelia burgdorferi. Among multiplicity manifestations of Lyme disease, musculoskeletal symptoms also occur. In the following article authors present epidemiology of Lyme disease, pathogenesis of antibiotic-refractory Lyme arthritis, symptoms, diagnosis and management of Lyme arthritis based on recent guidelines prepared by an expert panel of the infectious Diseases Society of America.