Objective To determine the frequency of chronic joint pain and stiffness 3 years after infection with chikungunya virus (CHIKV) in a Latin American cohort. Methods A cross-sectional followup of 120 patients from an initial cohort of 500 patients who reported joint pain 2 years after infection from the Atlántico Department, Colombia. Patients were clinically diagnosed as having CHIKV during the 2014–2015 epidemic, and baseline and followup symptoms at 40 months were evaluated in serologically confirmed cases. Results Of the initial 500 patients enrolled in the study, 482 had serologically confirmed chikungunya infection. From this group, 123 patients reported joint pain 20 months after infection, and 54% of those patients reported continued joint pain 40 months after infection. Therefore, 1 out of every 8 people who tested serologically positive for CHIKV infection had persistent joint pain 3 years after infection. Participants who followed up in person were predominantly adult (mean ± SD age 51 ± 14 yrs) and female (86%). The most common type of pain reported in these patients at 40 months post-infection was pain with periods of relief and subsequent reoccurrence, and over 75% reported stiffness after immobility, with 39% experiencing morning stiffness. Conclusion To our knowledge, this is the first report to describe persistent joint pain and stiffness 40 months after viral infection. The high frequency of chronic disease highlights the need to develop prevention and treatment methods. Further studies should be conducted to understand the similarities between post-chikungunya joint pain and rheumatoid arthritis.

To establish the effects of access time to high-quality temperate fresh forage (FF) on intake and performance of cows fed a total mixed ration (TMR), 9 Holstein cows were assigned to three 3 × 3 Latin squares with 20-d periods with sampling in the last 10 d. The following treatments were evaluated: 0 (T0), 4 (T4), and 8 (T8) h of daily access to FF. Forage (Lolium multiflorum) was cut daily and offered ad libitum beginning at 0800 h in individual stalls, and a TMR was offered ad libitum during the period when cows had no access to FF. Fresh forage dry matter intake (DMI) increased and TMR DMI decreased with the access time to FF, whereas total DMI was 3.0 kg higher for T4 than for T8; no differences were detected with T0. Compared with T0, 8h/d of access to FF decreased milk, protein, and casein yields, and tended to decrease fat and lactose yields, but treatment had no effect on milk composition or feed efficiency. The milk fatty acid profile in T8 had a higher content of rumenic, vaccenic, and linolenic acids compared with T0. We concluded that cows with 4h of access to high-quality FF had similar DMI and milk yields as cows fed only the TMR, but more than 4h of access reduced DMI and performance without changes in feed efficiency, although milk fat had enhanced levels of beneficial fatty acids.

Introduction/Objectives-To characterize the importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms.Method-Eighty-two patients were followed up 3 years after chikungunya infection. Tender and swollen joint counts, a pain intensity scale, Health Assessment Questionnaire-Disability Index (HAQ-DI), and the EuroQol EQ-5D quality of life instrument were completed. A musculoskeletal stiffness questionnaire provided scores for overall stiffness and its components: stiffness severity, physical impact, and psychosocial impact.Results-Patients had a mean age 51 ± 14 years. Sixty-seven patients were still experiencing chronic arthralgia. Musculoskeletal stiffness was reported by 43/67 patients with arthralgia and 3/15 patients without arthralgia. A physical impact of stiffness was reported by 87% patients and psychosocial impact by 71% patients. Mean tender joint count in patients reporting arthralgia was 6 ± 7, mean pain intensity 65 ± 20 out of 100, mean HAQ-DI was 0.54 ± 0.52, and mean EQ-VAS

Background:Musculoskeletal stiffness is reported to be frequent following chikungunya infection and can persist for many months after infection. However, stiffness severity and its impact is not well characterised in this disease. A stiffness patient reported outcome instrument has been developed for use in rheumatoid arthritis.Objectives:Our objective was to assess the use of this questionnaire and importance of musculoskeletal stiffness in a cohort of chikungunya patients with chronic joint symptoms in the Atlántico Department of Colombia.Methods:Sixty-seven patients with chronic arthralgia and 15 patients without arthralgia were followed up a mean of 40 months after chikungunya infection. The patients came from a larger cohort of 500 patients previously followed up 20 months after infection. Those consenting to a 40-month in-person follow-up were included here. Tender joint counts, a pain intensity visual analogue scale (VAS), Health Assessment Questionnaire-Disability Index (HAQ-DI) and the EuroQol overall health VAS (EQ-VAS) were completed. A 21-item musculoskeletal stiffness questionnaire (MSQ) was completed and summarized as percentage scores for overall stiffness and its components: stiffness severity, physical impact and psychosocial impact.Results:The 82 patients (12 male and 70 female) had a mean age 51±14 years. Forty-two out of sixty-seven patients with arthralgia and 3/15 patients without arthralgia reported musculoskeletal stiffness. Stiffness in those patients had a median severity of 28% (IQR 0-42). An impact of their stiffness on physical activities was reported by 39/45 patients (87%) and psychosocial impact by 32/45 patients (71%). Overall MSQ score was a median of 16% (IQR 0-34). Mean tender joint count in patients reporting arthralgia was 6.2±7.1, mean pain intensity 65±20 out of 100, mean HAQ-DI = 0.54±0.52, and a mean EQ-VAS = 68±62 out of 100.Overall stiffness scores were poorly correlated with tender joint counts (r2=0.17) and pain intensity (r2=0.22). Stiffness scores were more strongly associated with the HAQ-DI (r2=0.52) and EQ-VAS overall health VAS scores (r2=0.46), whereas tender joint counts were not: r2=0.22 for HAQ-DI and r2=0.21 for EQ-VAS.Conclusion:Musculoskeletal stiffness following chikungunya infection is distinct from the persistent arthralgia usually reported. It does not necessarily occur in the same patients and is poorly correlated with joint pain severity. Stiffness, as measured by this questionnaire, may be more strongly associated than arthralgia with overall health and disability indices in patients with chikungunya disease. The MSQ is a potentially useful instrument for assessing symptoms in chronic chikungunya disease.Disclosure of Interests: Hugh Watson Shareholder of: Sanofi, Employee of: Sanofi, Sarah Tritsch: None declared, Liliana Encinales: None declared, Andres Cadena: None declared, Carlos Cure: None declared, Alexandra Porras: None declared, Alejandro Rico Mendoza: None declared, Aileen Chang: None declared

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