Therapy for Chikungunya Arthritis: A Study of 133 Brazilian Patients

Author:

Amaral José Kennedy1,Bingham Clifton O.2,Taylor Peter C.3,Vilá Luis M.4,Weinblatt Michael E.5,Schoen Robert T.6

Affiliation:

1. Institute of Diagnostic Medicine of Cariri, Juazeiro do Norte, Brazil;

2. Johns Hopkins Arthritis Center, Johns Hopkins University School of Medicine, Baltimore, Maryland;

3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom;

4. Division of Rheumatology, Allergy and Immunology, University of Puerto Rico, San Juan, Puerto Rico;

5. Division of Rheumatology, Inflammation, and Immunity, Harvard Medical School Clinical, Boston, Massachusetts;

6. Section of Rheumatology, Yale University School of Medicine, New Haven, Connecticut

Abstract

ABSTRACT. Chikungunya fever is a global vector-borne viral disease. Patients with acute chikungunya are usually treated symptomatically. The arthritic phase may be self-limiting. However, many patients develop extremely disabling arthritis that does not improve after months. The aim of this study was to describe the treatment of chikungunya arthritis (CHIKA) patients. A medical records review was conducted in 133 CHIKA patients seen at a rheumatology practice. Patients were diagnosed by clinical criteria and confirmed by the presence of anti-chikungunya IgM. Patients were treated with methotrexate (20 mg/week) and/or leflunomide (20 mg/day) and dexamethasone (0–4 mg/day) for 4 weeks. At baseline visit and 4 weeks after treatment, Disease Activity Score 28 (DAS28) and pain (using a visual analog scale) were ascertained. Five months after the end of treatment, patients were contacted to assess pain, tender joint count, and swollen joint count. The mean age of patients was 58.6 ± 13.7 years, and 119 (85%) were female. After 4 weeks of treatment, mean (SD) DAS28-erythrocyte sedimentation rate (6.0 [1.2] versus 2.7 [1.0], P < 0.001) and pain (81.8 [19.2] to 13.3 [22.9], P < 0.001) scores significantly decreased. A total of 123 patients were contacted 5 months after the end of treatment. Pain score, tender joint count, and swollen joint count significantly declined after 4 weeks of treatment, and the response was sustained for 5 months. In this group of patients with CHIKA, 4-week treatment induced a rapid clinical improvement that was maintained 5 months after the end of therapy; however, the contribution of treatment to these outcomes is uncertain.

Publisher

American Society of Tropical Medicine and Hygiene

Subject

Virology,Infectious Diseases,Parasitology

Reference28 articles.

1. Chikungunya virus and the global spread of a mosquito-borne disease;Weaver,2015

2. Chikungunya in Brazil: rheumatologists on the front line;Amaral,2018

3. Rheumatic manifestations of chikungunya virus infection: prevalence, patterns, and enthesitis;Benjamanukul,2021

4. Prevalence of post-chikungunya infection chronic inflammatory arthritis: a systematic review and meta-analysis;Rodriguez-Morales,2016

5. Post-chikungunya chronic inflammatory rheumatism: results from a retrospective follow-up study of 283 adult and child cases in La Virginia, Risaralda, Colombia;Rodriguez-Morales,2016

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