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therapy), ribose powder, andrographis, eleuthero, glutathione, vitamin C, coenzyme Q10, alpha lipoic acid, vitamin B complex, vitamin B6, magnesium, omega-3, omega-6 and NT-factor. Despite the controversy among various groups and guidelines, all emphasize careful differential diagnosis and evaluation for other causes. At the BC Women’s Hospital and Health Centre, a Complex Chronic Diseases Program has been set up to provide care for patients with chronic LD as well as other pain syndromes. Patients with

symptoms compatible with chronic LD sometimes suffer for years, through countless clinical evaluations and tests without a proper diagnosis and effective treatment. It’s important that pharmacists understand the risks of contracting LD and the controversies concerning diagnosis, prophylaxis and treatment so that they can help patients navigate through the conflicting information. References available on request at info@bcpharmacy.ca. Comments or DPIC article topic suggestions can be sent to info@dpic.ca.

Table 1: Stages of Lyme disease: STAGE (INCIDENCE RATE)

SYMPTOMS

ONSET POST TICK BITE

Early localized

Erythema migrans (60-90%), flu-like symptoms (80%)

3 – 30 days

Early disseminated

Late disseminated

Cutaneous

Erythema migrans (60-90%), flu-like symptoms (80%)

Neurologic (3-15%) (neuroboreliosis)

Multiple erythema migrans (15%)

Musculoskeletal

Monoarticular/oligoarticular arthritis (brief attacks)

Cardiac (1-2%)

AV block, myopericarditis

Ocular (rare)

Conjunctivitis, uveitis, papillitis, episceleritis, keratitis

Late arthritis (<10%)

Intermittent/chronic monoarticular and oligoarticular arthritis (knee common) + peripheral neuropathy or encephalomyelitis (rare)

Weeks to months

Months to years

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