In the JournalsPerspective

Persistent arthritis reported in 25% of patients after chikungunya infection

Aileen Y. Chang

One-quarter of Latin American patients with the mosquito-borne chikungunya virus continued to have joint pain 20 months following the initial infection, according to findings published in Arthritis and Rheumatology.

“This study is the largest cohort study to follow a Latin American cohort of patients after chikungunya infection swept the western hemisphere for the first time,” Aileen Y. Chang, MD, MSPH, of George Washington University, in Washington, D.C., told Healio Rheumatology. “It is important because it describes the scope of the problem of chikungunya arthritis almost two years post infection.”

To determine the prevalence of chronic joint pain among patients infected with chikungunya virus in Latin America, Chang and colleagues conducted a cross-sectional follow-up of a prospective cohort of 500 patients from Colombia who had been clinically diagnosed with the virus in the 2014 to 2015 epidemic. They recorded symptoms among 485 serologically confirmed cases at baseline and at 20 months.

According to the researchers, small joints were the most commonly affected, including the wrists, ankles and fingers. Patients’ joint pain initially lasted a median of 4 days, and 16% of patients missed a median of 4 days of school or work. At the 20-month follow-up, 25% of participants experienced chronic joint pain. The researchers identified multiple significant predictors of persistent joint pain, including college graduate status, initial symptoms of headache or knee pain, missed work, normal activities affected, 4 or more days of initial symptoms and 4 or more weeks of initial pain.

The high prevalence of chronic joint pain underscores the importance of prevention and treatment efforts, the researchers wrote.

“The main takeaway was that one fourth of patients about 2 years post infection still complain of joint pain that they attribute to their chikungunya arthritis,” Chang said. “The clinical significance is that the western hemisphere has to prepare resources to be able to adequate take care of these patients and that developing specific effective treatments for this disease is imperative.” – by Jason Laday

Disclosure: The researchers report funding from the NIH National Center for Advancing Translational Sciences.

Aileen Y. Chang

One-quarter of Latin American patients with the mosquito-borne chikungunya virus continued to have joint pain 20 months following the initial infection, according to findings published in Arthritis and Rheumatology.

“This study is the largest cohort study to follow a Latin American cohort of patients after chikungunya infection swept the western hemisphere for the first time,” Aileen Y. Chang, MD, MSPH, of George Washington University, in Washington, D.C., told Healio Rheumatology. “It is important because it describes the scope of the problem of chikungunya arthritis almost two years post infection.”

To determine the prevalence of chronic joint pain among patients infected with chikungunya virus in Latin America, Chang and colleagues conducted a cross-sectional follow-up of a prospective cohort of 500 patients from Colombia who had been clinically diagnosed with the virus in the 2014 to 2015 epidemic. They recorded symptoms among 485 serologically confirmed cases at baseline and at 20 months.

According to the researchers, small joints were the most commonly affected, including the wrists, ankles and fingers. Patients’ joint pain initially lasted a median of 4 days, and 16% of patients missed a median of 4 days of school or work. At the 20-month follow-up, 25% of participants experienced chronic joint pain. The researchers identified multiple significant predictors of persistent joint pain, including college graduate status, initial symptoms of headache or knee pain, missed work, normal activities affected, 4 or more days of initial symptoms and 4 or more weeks of initial pain.

The high prevalence of chronic joint pain underscores the importance of prevention and treatment efforts, the researchers wrote.

“The main takeaway was that one fourth of patients about 2 years post infection still complain of joint pain that they attribute to their chikungunya arthritis,” Chang said. “The clinical significance is that the western hemisphere has to prepare resources to be able to adequate take care of these patients and that developing specific effective treatments for this disease is imperative.” – by Jason Laday

Disclosure: The researchers report funding from the NIH National Center for Advancing Translational Sciences.

    Perspective
    Vickie Sayles, BSN, CRNI, RN-BC

    Monica Richey

    The study done by Chang and colleagues highlights not only the large percentage (25%) of patients that developed persistent symptoms after being exposed to the chikungunya virus, but also the severity of their symptoms leading to chronic pain and possible disability.

    While the chikungunya virus was always more prevalent in the east, it caught millions by surprise when it reached the western hemisphere in 2014. However, what was most shocking was the severity of patient symptoms.

    The continued spread of mosquito-borne illness are related to world travel as well as overall changes in environment. Health care providers all over the world should always take a thorough travel history when investigating sudden onset of arthritis/arthralgia.

    Working in New York, I have seen several cases of chikungunya in patients who had travelled to the Caribbean and South America; in some of these patients, the symptoms were so severe that immediate treatment with antirheumatic medication was mandatory.

    This study reminds us that mosquito-borne viruses will continue to change and adapt to different environments. Therefore, it is our responsibility to research methods of prevention, develop first-line treatments and, most importantly, educate the population regarding the prevention of mosquito proliferation and when to seek medical assistance.

    • Monica Richey, MSN, ANP-BC/GNP
    • Board member, Rheumatology Nurses Society
      Nurse practitioner
      Division of rheumatology
      Northwell Health

    Disclosures: Richey reports no relevant financial disclosures.