Chikungunya-related arthritis likely to occur 20 months after infection
There appears to be a substantial number of patients developing chronic joint pain at a median of 20 months following infection with chikungunya virus (CHIKV), as shown in a study involving a large Latin American cohort.
“This is the first report to describe the frequency of chikungunya-related arthritis in the Americas after a 20-month follow-up. The high frequency of chronic disease highlights the importance of development of prevention and treatment interventions,” the authors said.
In the study, of the 500 patients examined during the 2014–2015 Colombian epidemic, 485 (mean age 49 years; 80 percent female) were serologically confirmed with CHIKV infection. The most common initial symptoms were joint pain (n=476), weakness (n=427), rash (n=409), fever (n=376), and headache (n=354). CHIKV infection symptoms lasted a median of 4 days (IQR, 3–8). [Arthritis Rheumatol 2017;doi:10.1002/art.40384]
Among patients with joint pain (median duration, 4 weeks; IQR, 2–16), majority reported pain in small joints including the wrists (90 percent), ankles (87 percent), and fingers (84 percent). Joint pain persisted 20 months after infection in one-fourth of the patients (n=123), with a mean global pain score in the previous week of 46.7.
Most patients with persistent joint pain exhibited one swollen joint but complained of tenderness in three other joints. Relative to patients without persistent joint pain, those who had were more likely to have missed work or school during initial infection (40 vs 8 percent; p<0.0001) and to have reported that their normal activities were affected by the initial symptoms (27 vs 4 percent; p<0.0001).
“Significant predictors of persistent joint pain included factors that may indicate a more severe or prolonged initial infection such as missed work [adjusted odds ratio (aOR), 5.23], normal activities affected [aOR, 8.80], ≥4 days of initial symptoms [OR, 2.69], and ≥4 weeks of initial joint pain [OR, 2.39],” the authors noted, adding that such risk factors should facilitate early identification of patients who may require follow-up care.
The finding that one-fourth of the patients infected with CHIKV developed chronic joint pain approximately 2 years after initial infection is consistent with those from other outbreaks of the Asian strain of the virus at 18 months (ie, persistent joint pain observed in one-third of patients) and lower than reported findings in 15–18-month follow-up of patients affected by the East Central African strain (ie, persistent joint pain seen in 43–75 percent of patients). [J Rheumatol 2016;43:440–444; Am J Trop Med Hyg 2016;94:800-803; PLoS Negl Trop Dis 2009;3:e389; BMC Med 2011;9:1; Clin Infect Dis 2007;44:1401-1407]
Despite the presence of several limitations and the inclusion of Colombian and predominantly mestizo women, the study has important implications for planning of CHIKV outbreak control management, the authors said.