Robert T. Schoen
Although there remain limited studies and a lack of rigorous trials, available evidence suggests that methotrexate may be an effective and safe treatment for chronic chikungunya arthritis, according to findings published in Arthritis Care and Research.
“Over the past 10 years, chikungunya fever has re-emerged as an important infection throughout the tropical and subtropical world,” Robert T. Schoen, MD, MBA, from the section of rheumatology at Yale University School of Medicine, told Healio Rheumatology. “Many chikungunya patients develop chronic painful arthritis. Rheumatologists need effective therapy to treat these patients.”
To analyze the available evidence regarding the efficacy and safety of methotrexate in the treatment of chronic chikungunya arthritis, Schoen and colleagues conducted a systematic literature review. Focusing on methotrexate as monotherapy or in combination with other treatments, the researchers searched PubMed, Scielo, Scopus, Google Scholar, the International Clinical Trials Registry, clinicaltrials.gov and the Cochrane Library from inception to August 2017.
Starting with 131 potentially relevant studies, the researchers narrowed their review to 6 trials that met their criteria. Among them, 4 were retrospective studies, 1 was an uncontrolled prospective study and 1 was an unblinded randomized clinical trial of methotrexate as part of a combination therapy.
According to the researchers, the best study available was the single randomized trial, which evaluated 72 patients with chikungunya arthritis who experienced an inadequate response to sulfasalazine. This study indicated that methotrexate, used in combination with hydroxychloroquine and sulfasalazine, was “superior” to sulfasalazine alone as a treatment for chronic chikungunya arthritis, as determined by the Disease Activity Score (DAS28ESR 3.39+/–0.87 vs. 4.74+/–0.65; P < .0001) and the Health Assessment Questionnaire (HAQ 1.14+/–0.31 vs. 1.88+/–0.47; P < .0001), the researchers wrote.
“More studies are needed, both for clinical and pathogenic, but available evidence suggests that methotrexate may be effective and safe for the treatment of chronic chikungunya arthritis,” Schoen said. “We still do not understand the cause of chronic chikungunya arthritis. Is this a post-infectious inflammatory process, or is arthritis driven by viral persistence? However, chronic chikungunya arthritis patients are seeking treatment now. This study evaluates the current evidence for the use of methotrexate in chronic chikungunya arthritis.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.