Lyme disease also affects the connective tissue. It manifests itself in particular in the elastic and collagen fibers of the skin, tendons and ligaments. The fibers represent the ideal retreat for Borrelia, as the body's defenses in these structures has only limited possibilities. They also represent the ultimate host tissue in which to be the causative agent of action of antibiotics largely unaffected. Therefore, tendons and ligaments playing for the chronicity of Lyme disease in addition to the immune dysfunction a crucial role. While the specific manifestations of more and more lead to the skin to adequate therapeutic intervention, functional damage to tendons and ligaments usually remain unnoticed. It is therefore necessary that any rupture of tendons and ligaments, with spontaneous dislocation of skeletal parts (eg vertebrae) without adequate trauma exposure or with any chronic irritation without proper stress (eg "tennis elbow" without stress) or chronic inflammation, frequent relapses inflammation or significantly delayed healing of tendons and ligaments after traumatic injury to a Lyme disease is excluded. Major differential diagnoses in this context are progressive scleroderma, mixed connective tissue disease (Sharp syndrome, MCTD), lupus erythematosus (LE) and Sjögren's syndrome.